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# Intermediate cuneiform

The intermediate cuneiform is the smallest wedge-shaped midfoot bone, behind the second metatarsal.

Official name: Intermediate cuneiform bone

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## What it is

The smallest of three wedge-shaped bones in the midfoot, behind the second metatarsal.

## What it does

Their wedge shape helps form the cross arch of the foot. It sits a little back, so the second metatarsal locks in like a keystone.

## Key points

- Because the second metatarsal base sits locked in its recess, the second tarsometatarsal joint is the least mobile of the foot and a weak point in Lisfranc injuries
- On a standing AP view the medial border of the second metatarsal must line up with its medial border; any step suggests a Lisfranc injury
- Separation between it and the medial cuneiform is an intercuneiform variant of the Lisfranc injury

## Key facts

**Joints with**
Navicular; medial and lateral cuneiforms; second metatarsal

**Landmarks**
Smallest cuneiform; set back, forming a recess that locks the base of the second metatarsal; slip of tibialis posterior

## Relations

**Behind**
[Navicular](https://durgical.com/en/anatomy/navicular-bone/), middle facet

**In front**
Base of the [second metatarsal](https://durgical.com/en/anatomy/second/)

**Medial**
[Medial cuneiform](https://durgical.com/en/anatomy/medial-cuneiform-bone/); the Lisfranc ligament passes deep to the joint between them to the second metatarsal

**Lateral**
[Lateral cuneiform](https://durgical.com/en/anatomy/lateral-cuneiform-bone/)

**Above**
The [dorsalis pedis artery](https://durgical.com/en/anatomy/dorsalis-pedis-artery/) and [deep fibular nerve](https://durgical.com/en/anatomy/deep-fibular-nerve/) run over the dorsum near it, lateral to the [extensor hallucis longus](https://durgical.com/en/anatomy/extensor-hallucis-longus/) tendon

**Below**
Plantar ligaments and a slip of [tibialis posterior](https://durgical.com/en/anatomy/tibialis-posterior-muscle/)

## How to find it

Hard to identify alone; it lies on the dorsum in line with the second metatarsal, roughly where the dorsalis pedis pulse is felt between the extensor hallucis longus and [extensor digitorum longus](https://durgical.com/en/anatomy/extensor-digitorum-longus/) tendons.

## Examination

- Midfoot stress (pronation–abduction) test: with the heel held still, twisting the forefoot outward that causes pain at the tarsometatarsal joints suggests a Lisfranc injury
- Piano key test: moving the second metatarsal head up and down reproduces midfoot pain at its base in a Lisfranc injury
- Single-leg heel raise: being unable to rise onto the toes, or pain in the midfoot when trying, suggests an unstable tarsometatarsal complex

## On imaging

Standing AP foot view to check its alignment with the second metatarsal base; CT shows the recessed mortise, small avulsions and intercuneiform widening.

## Common problems

- Can be involved in Lisfranc (midfoot) injuries and midfoot arthritis.

## Clinical notes

- Midfoot arthritis after a Lisfranc injury most often affects the second and third tarsometatarsal joints, the stiff middle column
- Surgical fixation of Lisfranc injuries restores the second metatarsal in its mortise between the cuneiforms
- Bruising on the sole of the midfoot after an injury (plantar ecchymosis sign) points to a Lisfranc injury

## Development

The last cuneiform to ossify, around age 3.

## Test yourself

Think of the answer, then tap the question to see it.

## Why is the second tarsometatarsal joint the least mobile of the foot?

The intermediate cuneiform is set back, so the second metatarsal base sits locked in its recess.

## On a standing AP foot view, which alignment is checked at the intermediate cuneiform?

The medial border of the second metatarsal must line up with the medial border of the intermediate cuneiform; any step suggests a Lisfranc injury.

## Which is the smallest cuneiform and the last to ossify?

The intermediate cuneiform, ossifying around age 3.

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Educational information, not medical advice. For any symptom, see a health professional.

## Its names

**Official Latin (TA2)**
os cuneiforme intermedium TA2 1487

**Official Spanish (DeCS)**
Hueso cuneiforme intermedio DeCS D013639

**English (TA2)**
Intermediate cuneiform bone

**Also called**
second cuneiform · Cuneiform 2 · middle cuneiform bone · os cuneiforme secundum

## Related

- [Navicular](https://durgical.com/en/anatomy/navicular-bone/)
- [Medial cuneiform](https://durgical.com/en/anatomy/medial-cuneiform-bone/)
- [Lateral cuneiform](https://durgical.com/en/anatomy/lateral-cuneiform-bone/)
- [Second metatarsal](https://durgical.com/en/anatomy/second/)
- [Extensor hallucis brevis](https://durgical.com/en/anatomy/extensor-hallucis-brevis/)
- [Lisfranc ligaments](https://durgical.com/en/anatomy/cuneometatarsal-interosseous-ligaments/)
- [Top-of-midfoot ligaments](https://durgical.com/en/anatomy/dorsal-cuneonavicular-ligaments/)
- [Sole-side midfoot ligaments](https://durgical.com/en/anatomy/plantar-cuneonavicular-ligaments/)

Sources: Terminologia Anatomica (TA2); [DeCS](https://decs.bvsalud.org/es/ths/resource/?id=23476&filter=ths_termall&q=Huesos%20Tarsianos); [Anatomy, Bony Pelvis and Lower Limb: Foot and Ankle](https://www.ncbi.nlm.nih.gov/books/NBK546698/).

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Representative model, for educational purposes only.

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Source: https://durgical.com/en/anatomy/intermediate-cuneiform-bone/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/anatomy/intermediate-cuneiform-bone/