Barlow reported the first case of bilateral bipartite medial cuneiform in a cadaver foot in the 18th century. The incidence of bipartite medial cuneiform is 1 in 320.3 There have been only 3 reports in the literature citing bipartite medial cuneiform in a living patient as an incidental finding. Barclay4 reported a case of a 34-year-old male jockey with navicular fracture and an incidental medial cuneiform. The other case report was cited by Dellacorte et al3 in 1992. The bipartite medial cuneiform was detected by computed tomography that was performed to assess for fracture of the intermediate cuneiform. O'Neal et al2 described the presence of a bipartite medial cuneiform in a 5-year-old boy's amputated leg.
A literature search showed only 2 reported cases of a symptomatic bipartite medial cuneiform. In 2001, Azurza and Sakellariou1 reported a case of bipartite medial cuneiform in 34-year-old soldier with chronic left foot pain after a soccer injury. He was successfully treated with osteosynthesis. Chiodo et al5 presented a case of symptomatic medial cuneiform in 2002 in a 32-year-old female marathon runner with exertional left midfoot pain. Weight-bearing radiographs of the symptomatic foot revealed a bipartite medial cuneiform.
We present a case of a symptomatic bipartite medial cuneiform, which was seen on plain radiographs. MRI, as stated above, showed increased signal in the uppermost medial cuneiform and superior aspect of the inferior medial cuneiform. This suggests marrow edema, which was likely caused by a minor traumatic event and led to the symptoms in this patient. The tarsal anomaly may have allowed a relatively minor traumatic event to cause significant long-term symptoms due to altered biomechanics within the midfoot.6
A bipartite medial cuneiform is an uncommon anomaly that is rarely symptomatic. This type of developmental anomaly of the foot may change the biomechanics of the tarsal bones, which can allow minor injuries to cause disproportionately severe symptoms. A relatively minor acute injury can ultimately lead to chronic inflammation and long-term pain, as was the case in this patient.
Symptomatic bipartite medial cuneiform. Appl Radiol.