Age / Sex : 8 / M

Osteochondrosis of medial cuneiform, bilateral

Discussion

Findings:

Plain radiography

1. Geographic mixed lucency and sclerosis involving medial cuneiform bilaterally

MRI (left ankle)

1. Preserved normal marrow fat


2. Focal increased SI dorsomedially, could be due to previous sprain


3. No soft tissue mass nor inflammatory change around medial cuneiform


4. Ligaments and tendons are preserved (not shown)

 Differential Diagnosis:

1. Osteochondrosis


2. Other possibilities are less likely

• - LCH, tuberculous osteomyelitis,


• - Ewing’s sarcoma

Diagnosis:  

Osteochondrosis of medial cuneiform, bilateral

Discussion:

Osteochondrosis of medial cuneiform

- Relatively rare in tarsal osteochondrosis

- 2.5~8 years, Boys>

- Medial cuneiform (66.7%) > intermediate(27.8%) > lateral(5.5%)

- Bilateral 61%

- Small sclerotic cuneiform with marginal irregularity

- Self-limiting - regain normal size and density in 6~24 months

DDx: Ewing’s sarcoma, Osteomyelitis, LCH, Frostbite

References:

1. F Calderazzi et al. Trauma Cases Rev 2016, 2:037


2. Z Atbasi, et al. Foot Ankle Spec.2013 Apr;6(2):154-8