Biomechanical Findings in Patients with Bipartite Medial Cuneiforms

Bipartite medial cuneiforms are relatively rare but may play a significant role in biomechanical and gait abnormalities. It is believed that a bipartite medial cuneiform may alter the available range of motion due to its larger morphological variant, thus limiting the metatarsal plantarflexion needed to achieve adequate hallux dorsiflexion for normal gait. Radiographic and clinical assessment were performed on two patients who reported with foot pain along the first ray. Both patients had visible bipartite medial cuneiforms on MRI. Using gait plate and Metascan ™ analysis, both were noted to have four measurements far beyond the expected range. Medial and lateral heel peak pressure, hallux peak pressure, and 1st metatarsal peak pressure were all noted to be increased. These measurements are believed to be increased due to the hindrance placed on the available ROM of the first ray by the increased size of the medial cuneiform. A larger patient population would be needed to fully understand this developmental anomaly.





References:
[1] Azurza K, Sakellariou A. “Osteosynthesis of a symptomatic bipartite medial cuneiform,” Foot and Ankle International, vol 22, pp 499-501, 2001.
[2] Bismil Q, Foster PAL, Venkateswaran B, Shanker J., “Symptomatic bipartite medial cuneiform after injury: a case report,” Foot and Ankle Surgery, vol 11, pp55-58, 2005.
[3] Chiodo CP, Parentis MA, Myerson MS, “Symptomatic bipartite medial cuneiform in an adult athlete: a case report,” Foot and Ankle International vol 23, pp348-351, 2002.
[4] Eves, Timothy B. et al, MRCS, “Sports injury to a bipartite medial cuneiform in a child,” The Journal of Foot and Ankle Surgery vol 53, issue 2, pp232-234, 2014.
[5] Geraldine H. Chang, Eric Y. Chang, Christine B. Chung, and Donald L. Resnick, “Bipartite Medial Cuneiform: Case Report and Retrospective Review of 1000 Magnetic Resonance (MR) Imaging Studies,” Case Reports in Medicine, vol. 2014, Article ID 130979, 4 pages, 2014. doi:10.1155/2014/130979
[6] Jashashvili, T., Ponce de León, M. S., Lordkipanidze, D. and Zollikofer, C. P. E. (2010), First evidence of a bipartite medial cuneiform in the hominin fossil record: a case report from the Early Pleistocene site of Dmanisi. Journal of Anatomy, 216: 705–716. doi: 10.1111/j.1469-7580.2010.01236.x
[7] Panu, MD FRCP, G. Konin, MD, G. Saboeiro, MD, “Symptomatic bipartite medial cuneiform treated with fluoroscopic and ultrasound-guided injections,” Hospital for Special Surgery vol 10, no. 1, pp 92-97, 2013.
[8] R. Phillips, E. Law, E. Ward, “Functional motion of the medial column joints of the foot during propulsion,” The Journal of American Podiatric Medical Association, 86(10), pp 478-86, 1996.
[9] Steen E., Brancheau S., Nguyen T., Jones M., Schade V., “Symptomatic bipartite medial cuneiform: report of five cases and review of the literature,” Foot and Ankle Specialist, vol 20, no. 10, pp 1-10, 2015.
[10] U. Fulwadhva, R. Parker, “Symptomatic bipartite medial cuneiform,” Applied Radiology 3(7), pp 42-44, 2007.
[11] O’Neal ML, Ganey TM, Ogden JA. Fracture of a bipartite medial cuneiform synchondrosis. Foot & Ankle International 1995; 16(1):37-40.
[12] T.E. Barlow, “Os cuneiform 1 bipartum,” American Journal of Physical Anthropology, vol.29, no. 1, pp.95-111, 1942.
[13] A. Kjellstrom, “A case study of os cuneiform mediale bipartum from sigtuna, Sweden,” International Journal of Osteoarchaelogy, vol 14, no. 6, pp. 475-480, 2004.
[14] T. Smith, “A foot having four cuneiforms,” Trans Pathol Soc Lond 17, 222-223, 1866.
[15] Burnett SE, Case DT. Bipartite medial cuneiform: new frequencies from skeletal collections and a meta-analysis of previous cases, Homo 62:109-125,2001.
[16] Barclay M. A case of duplication of the internal cuneiform bone of the foot [cuneiform bipartitum]. J Anat 67(Pt 1):175-177, 1932.
[17] Ebisui JM: The first ray axis and the first metatarsophalangeal joint: an anatomical and pathomechaniccal study. JAPA 58: 160, 1968.
[18] Hicks JH: Mechanics of the foot: part 1. The joints. J Anat 87: 345, 1953.
[19] Root ML, Orien WP, Weed JH: Normal and Abnormal Function of the Foot, Clinical Biomechanics, Clinical Biomechanics Corporation, Los Angeles, 1977.
[20] Ouzounian T, Shereff M: In vitro determination of didfoot motion. Foot Ankle 10: 140, 1989.
[21] Wanivenhaus A, Pretterklieber M: First tarsometatarsal joint: anatomical biomechanical study. Foot Ankle 9: 153, 1989.
[22] Gruber W. Uber Die Beiden Arten Des Uberzahligen Zwischenknochelcheens am Rucken des Metatarsum und uber den durch Ankylose eines dieser Knochelchen entstandenen und eine Knochelchen entstandenen und eine Exostone am Os cuneiform I und os metatarsale II vortauchenden Fortsatz. Arch Pathol Anat Physiol Klin Med. 1877;71:440–452. doi: 10.1007/BF01941931
[23] Elias I, Dheer S, Zoga AC, Raikin SM, Morrison WB. Magnetic resonance imaging findings in bipartite medial cuneiform – a potential pitfall in diagnosis of midfoot injuries: a case series. Journal of Medical Case Reports 2008; 2:272.
[24] Pfitzer W. Beitrage zur Kenntniss des Menschlichen Extremitatenskelets. IV Die Variationen in Aufbau des FussKelets. Morphologische Arbeiten 1st edn Verlag Germany, 1986; pp 245–515.
[25] Trolle D. Accessory bones of the humanfoot: a radiological, histo-embryological, comparative anatomical, and genetic study. 1948 Munksgaa rd, Copenhagen
[26] Buell T, Green DR, Risser J. Measurement of the first metatarsophalangeal joint range of motion. J Am Pod Med Assoc 1988;78:439-48.