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Intermediate cuneiform bone

The intermediate cuneiform (second cuneiform) is the smallest of the three cuneiform bones, located in the midfoot between the medial and lateral cuneiforms. It lies at the base of the second metatarsal, contributing to the Lisfranc (tarsometatarsal) joint complex. This bone plays a central role in stabilizing the longitudinal and transverse arches of the foot.

Synonyms

  • Second cuneiform bone

  • Middle cuneiform bone

Joints

  • Proximally: Articulates with the navicular

  • Distally: Articulates with the base of the 2nd metatarsal

  • Medially: Articulates with the medial cuneiform

  • Laterally: Articulates with the lateral cuneiform

Ligament Attachments

  • Dorsal and plantar tarsometatarsal ligaments (to the 2nd metatarsal)

  • Intercuneiform ligaments (binds medial, intermediate, and lateral cuneiforms together)

  • Lisfranc ligament (medial cuneiform to base of 2nd metatarsal): indirectly stabilizes the intermediate cuneiform

Tendon and Muscle Relations

  • Insertion: Tibialis posterior tendon inserts into the intermediate cuneiform (among multiple midfoot insertions)

  • Overlying tendons: Extensor hallucis longus and extensor digitorum longus cross dorsally; flexor tendons pass plantar to the bone

Nerve Supply

  • Deep peroneal nerve: Dorsal innervation of tarsometatarsal joint

  • Medial plantar nerve: Contributes to plantar innervation of cuneiform region

Arterial Supply

  • Dorsalis pedis artery: Provides branches to dorsal aspect

  • Medial plantar artery (branch of posterior tibial): Supplies plantar surface

  • Lateral plantar artery contributions via plantar arch

Venous Drainage

  • Dorsal venous network → great saphenous vein (medial) and small saphenous vein (lateral)

  • Deep veins follow arterial supply into dorsalis pedis and posterior tibial veins

Function

  • Provides a stable base for the second metatarsal

  • Supports transverse and longitudinal foot arches

  • Acts as a keystone in the Lisfranc joint complex, critical for midfoot stability

Clinical Significance

  • Fractures: Rare, but may occur in high-energy midfoot trauma

  • Lisfranc injury: Disruption at the base of the 2nd metatarsal involving the intermediate cuneiform → instability of midfoot

  • Stress fractures: May occur in repetitive athletes or military recruits

  • Arthritis: Can develop post-traumatically at intercuneiform or tarsometatarsal joints

  • Imaging role: MRI/CT essential for detecting occult fractures and Lisfranc disruptions

MRI Appearance

  • T1-weighted images:

    • Normal marrow: intermediate-to-high signal depending on fat content

    • Cortical bone: uniformly low signal (dark rim)

    • Fractures: linear low-signal lines through marrow

    • AVN: diffuse low signal

  • T2-weighted images:

    • Normal marrow: intermediate to high signal depending on fat

    • Cortical bone: low signal

    • Marrow edema or fracture: bright hyperintense signal

  • STIR:

    • Normal marrow suppressed (dark)

    • Pathology (fractures, edema, contusions): bright hyperintense signal

  • Proton Density Fat-Saturated (PD FS):

    • Normal: homogeneous low-intermediate signal

    • Pathology: fractures, cartilage injury, and edema show bright focal abnormalities

  • T1 Fat-Sat Post-Contrast:

    • Normal: mild uniform marrow enhancement

    • Infection or fracture healing: heterogeneous or rim enhancement

    • AVN: non-enhancing necrotic region with peripheral enhancement

MRI Arthrogram Appearance

  • Contrast highlights tarsometatarsal and intercuneiform joint spaces

  • Subtle cartilage or cortical surface defects become conspicuous

  • Useful in suspected Lisfranc ligament injuries when conventional MRI is equivocal

CT Appearance

Non-Contrast CT:

  • Excellent cortical bone detail

  • Fractures: sharply delineated cortical disruption or comminution

  • Cortical bone: dense high-attenuation rim

  • Stress fractures: linear cortical thickening or lucency

  • Chronic changes: sclerosis, arthritic joint narrowing, osteophytes

CT Arthrogram Appearance

  • Contrast outlines tarsometatarsal and intercuneiform joints

  • Fractures or cartilage defects: contrast enters subchondral or cortical gaps

  • Helpful for subtle Lisfranc injuries and cartilage surface evaluation when MRI is contraindicated

CT VRT 3D image

Intermediate cuneiform bone 3d

MRI image

Intermediate cuneiform bone MRI axial cross sectional anatomy 3T MRI AI enhanced radiology image-img-00000-00000

MRI image

Intermediate cuneiform bone MRI coronal cross sectional anatomy 3T MRI AI enhanced radiology image-img-00000-00000

CT images

Intermediate cuneiform bone ct axial

X Ray image

Intermediate cuneiform bone