Introduction: Osteonecrosis is a condition that rarely affects the bones of the foot and, when present, is more common in the talus and navicular. Osteonecrosis of the cuneiforms is extremely rare, with only a few case reports described in the literature, most of which were in pediatric patients. There are no case reports of this disease in the lateral cuneiform, let alone in the adult population.
Objective: Presenting this unique case of an adult patient with osteonecrosis of the lateral cuneiform who underwent surgical treatment.
Methods: A 42-year-old female patient with progressive pain in the left midfoot that rendered full weight bearing gait impossible. There are no known comorbidities and no history of trauma or intense sports activity in the previous months. Apart from tenderness and swelling, there are no exuberant clinical signs.
Magnetic resonance imaging showed dorsal hypodensity of the lateral cuneiform, suggestive of avascular necrosis, with no signs of bone collapse.
Due to failure of conservative treatment, the patient underwent surgical treatment with subchondral drilling.
Results: No postoperative complications were recorded. After 3 months of surgery, the patient was walking pain-free with full weight-bearing and showed signs of revascularization in magnetic resonance imaging.
Currently with excellent clinical progress, with significant improvement in both the AOFAS score (from 35/100 to 90/100) and the visual analogue pain scale (from 8/10 to 1/10). The patient classified the result as excellent and would recommend it to anyone.
Conclusion: Osteonecrosis of the lateral cuneiform is an exceptionally rare condition, this report being the first of its kind. Like in other anatomical areas, it can be successfully treated with surgical decompression with subchondral drilling in the early stages.
International Journal of Case Reports in Orthopaedics
