Topics

Topic

design image
Lateral cuneiform bone

The lateral cuneiform bone is the third (intermediate) cuneiform, located in the midfoot between the intermediate cuneiform medially and the cuboid laterally. It articulates posteriorly with the navicular and anteriorly with the base of the third metatarsal. This wedge-shaped bone is an essential component of the tarsometatarsal (Lisfranc) joint complex, contributing to foot stability and weight transfer during gait.

Joints

  • Proximally: Articulates with navicular

  • Distally: Articulates with base of third metatarsal

  • Medially: Articulates with intermediate cuneiform and base of second metatarsal

  • Laterally: Articulates with cuboid and base of fourth metatarsal

Ligament Attachments

  • Dorsal and plantar tarsometatarsal ligaments attach to third metatarsal

  • Interosseous cuneometatarsal ligaments connect lateral cuneiform to bases of second and third metatarsals

  • Intercuneiform ligaments link it to intermediate cuneiform

  • Cuneocuboid ligament connects it to cuboid

Tendon and Muscle Attachments

  • Peroneus longus tendon: Passes obliquely under foot, inserting partly into lateral cuneiform (and first metatarsal, medial cuneiform)

  • Tibialis posterior tendon: Inserts partly into lateral cuneiform (with attachments to navicular, cuboid, medial cuneiform, and metatarsals)

  • Flexor hallucis brevis: Originates partly from plantar aspect of lateral cuneiform

Nerve Supply

  • Deep peroneal nerve: Dorsal articular innervation

  • Medial plantar nerve (branch of tibial): Plantar innervation

  • Lateral plantar nerve: May contribute to plantar capsule innervation

Arterial Supply

  • Dorsalis pedis artery: Via arcuate branch and dorsal metatarsal arteries

  • Medial plantar artery: Supplies plantar aspect

  • Lateral plantar artery: Contributes through plantar arch connections

Venous Drainage

  • Drains dorsally to dorsal venous arch and dorsalis pedis vein

  • Plantar drainage via medial and lateral plantar veins into posterior tibial vein

Function

  • Forms part of Lisfranc joint complex, stabilizing midfoot

  • Acts as a keystone for lateral longitudinal and transverse foot arches

  • Distributes body weight from hindfoot to forefoot

  • Provides insertion points for tendons aiding foot movement

Clinical Significance

  • Fractures: May occur in high-energy trauma or Lisfranc injury patterns

  • Lisfranc injury: Often involves disruption of ligaments attached to lateral cuneiform

  • Stress injuries: Seen in athletes due to repetitive loading

  • Arthritis: Midfoot arthritis may involve intercuneiform and cuneometatarsal joints

  • Imaging role: CT excellent for fractures; MRI essential for occult injuries and ligament assessment

MRI Appearance

  • T1-weighted images:

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

    • Cortical bone: low signal (dark rim)

    • Fracture lines: linear low-signal defects

    • AVN or sclerosis: diffuse low-signal marrow

  • T2-weighted images:

    • Marrow: intermediate to high signal depending on fat content

    • Cortical bone: uniformly low signal

    • Edema or fracture: bright hyperintense signal

    • Stress reaction: subtle increased signal without cortical break

  • STIR:

    • Normal marrow: dark suppressed signal

    • Pathology (fractures, edema, osteonecrosis): bright hyperintense

  • Proton Density Fat-Saturated (PD FS):

    • Normal: homogeneous low-intermediate signal with dark cortex

    • Pathology: bright signal changes outlining fractures, edema, or early osteonecrosis

  • T1 Fat-Sat Post-Contrast:

    • Normal: mild homogeneous enhancement

    • AVN: non-enhancing necrotic core with rim enhancement

    • Active inflammation or arthritis: diffuse enhancement of bone and soft tissues

MRI Arthrogram Appearance

  • Contrast highlights tarsometatarsal and intercuneiform joint spaces

  • Lisfranc injury: contrast tracks between disrupted intercuneiform ligaments

  • Cartilage defects: contrast extends into fissures

CT Appearance

Non-Contrast CT:

  • Excellent detail of cortical margins

  • Fractures: clearly visible with cortical disruption and fragment displacement

  • Stress fractures: appear as subtle cortical sclerosis or linear lucencies

  • Arthritis: joint space narrowing, osteophytes, and subchondral sclerosis

CT Arthrogram Appearance

  • Contrast outlines tarsometatarsal and intercuneiform joint spaces

  • Ligament tears: contrast extravasation into abnormal recesses

  • Cartilage defects: contrast pools in subchondral defects

  • Especially useful in Lisfranc injury assessment and when MRI contraindicated

CT VRT 3D image

Lateral cuneiform bone 3d

MRI image

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

MRI image

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

CT images

Lateral cuneiform bone ct axial

X Ray image

Lateral cuneiform bone