Ankle and Foot Conditions

Bi-partate cuneiform is a rare anatomical variant. Currently, I have the largest series of these cases. Over my career, I have collected over 50. No published series has ever seen more then five. Although uncommon, these are often misdiagnosed as a fracture. Patients with this anatomical variant are subject to midfoot DJD and injury. Like accessory bones, once injured they rarely will improve requiring surgical intervention.
Every case has had similar characteristics: two part medial cuneiform dividing the cuneiform into a dorsal and plantar piece. The navicular instead of being rounded at the naviculocuneiform joint comes to a point.	On the AP view, it is often difficult to see the two halves overlapping and this case is one of the easiest to see of the 50+ cases.
Symptomatic cuneiform	CT-SCAN illutstrating the two-parts of the cuneiform
Cystic medial cuneiform	The intra-cuneiform space is arthritic and cystic which required fusion