Avascular necrosis of the intermediate cuneiform bone in a child: a very rare cause of limp in a child. A variant of the normality?

Abstract

Only four cases of avascular necrosis in the intermediate cuneiform bone have been described. A new case of avascular necrosis of the intermediate cuneiform bone as a very rare cause of limp is presented. A boy aged 4 years and 4 months came to the clinic with a 1-month history of pain in the left foot and on palpation of the base of the third metatarsal of the left foot. There were no signs of inflammation, bruising, erythema or fever. In the radiograph, a clear increase in the radiological density of the second cuneiform bone was seen. No treatment was prescribed. The symptoms remitted spontaneously after 2 weeks. The pain did not return and the patient was asymptomatic after 3 months. Five months later he presented a normal radiograph, continuing to be completely asymptomatic. One year later, he remained asymptomatic and carried out normal sports activities. A high index of suspicion is necessary with the aim of avoiding the performance of superfluous diagnostic tests (laboratory tests, MRIs or technetium-99 bone scans). The indication of treatments should be avoided, including conservative treatments such as shoe inserts or casts. Given its benign nature as well as the possibility of it presenting with no symptoms, we believe that it may be considered as a variant of normality.