Accessory medial cuneiform bone in a child: unreported site and review of literature


  • Waleed Saqer Department of Orthopedic Surgery, King Hamad University Hospital, Bahrain
  • Atul Bandi Department of Orthopedic Surgery, King Hamad University Hospital, Bahrain
  • Salman Hasan Department of Orthopedic Surgery, King Hamad University Hospital, Bahrain
  • Maged Mostafa Department of Orthopedic Surgery, King Hamad University Hospital, Bahrain
  • Ahmed Refaat Khamis Department of Orthopedic Surgery, Benha University Hospital, Egypt



Accessory ossicle, Digital nerve, Os cuneo-I metatarsale- I dorsale


Accessory ossicles of the foot are not uncommon finding in foot radiographs which has confused radiologists and orthopedic surgeons from time immemorial. Occasionally these bones are symptomatic, hindering daily activities of patients. We present a case report of an eleven years old girl with a symptomatic accessory medial cuneiform on the dorsal aspect of left foot. The child was evaluated radiologically and after a trial of failed conservative treatment, she was operated upon. Intraoperatively a superficial nerve on dorsum of this accessory ossicle was found, and the extra bone was excised. This accessory bone was found to be related to medial cuneiform bone at its dorsal and distal surface making to suggest its name as "Os cuneo-I metatarsale-I dorsale". Detailed radiological evaluation is mandatory for identification and exact anatomical localization of the extra bone before proceeding to excision, when non operative treatment fails to relieve the symptoms.



- Coskun N, Yuksel M, Cevener M, Arican RY, Ozdemir H, Bircan O, Sindel T, Ilgi S, Sindel M. Incidence of accessory ossicles and sesamoid bones in the feet: a radiographic study of the Turkish subjects. Surg Radiol Anat. 2009;31:19–24.

- Jones, S. Right foot showing two internal cuneiform bones. Trans Pathol Soc. 1864;15:189-190.

- Smith, T. A foot having four cuneiform bones. Trans Pathol Soc. 1865;17:222-223.

- Lee JH, Kyung MG, Cho YJ, Go TW, Lee DY. Prevalence of Accessory Bones and Tarsal Coalitions Based on Radiographic Findings in a Healthy, Asymptomatic Population. Clinics in Orthopedic Surgery. 2020 Jun;12(2):245.

- Tsuruta T, Shiokawa Y, Kato A, Matsumoto T, Yamazoe Y, Oike T, Sugiyama T, Saito M. Radiological study of the accessory skeletal elements in the foot and ankle (author's transl). Nihon Seikeigeka Gakkai Zasshi. 1981 Apr 1;55(4):357-70.

- Keles-Celik N, Kose O, Sekerci R, Aytac G, Turan A, Güler F. Accessory ossicles of the foot and ankle: disorders and a review of the literature. Cureus. 2017 Nov;9(11).

- Tonogai I, Nishisho T, Takao S, Miyagi R, Yokoyama K, Toki S, Sairyo K. Symptomatic Os Intercuneiform: A Case Report. The Journal of Foot and Ankle Surgery. 2018 Sep 1;57(5):997-9.

- Kurashige T. Removal of Painful Os Paracuneiforme: A Case Report. Foot & Ankle Specialist. 2020 Jun;13(3):236-41.

- Chiodo CP, Parentis MA, Myerson MS. Symptomatic bipartite medial cuneiform in an adult athlete: a case report. Foot & ankle international. 2002 Apr;23(4):348-51.

- Nakasa T, Fukuhara K, Adachi N, Ochi M. Painful os intermetatarseum in athletes: report of four cases and review of the literature. Archives of orthopaedic and trauma surgery. 2007 May 1;127(4):261-4.