Aseptic osteonecrosis of the lateral cuneiform and proximal epiphysis of the third metatarsal bones: a case report

Aseptic osteonecrosis of the tarsal bones sometimes occurs in tarsal navicular bone and metatarsal head in young patients. There are a few studies that have reported aseptic osteonecrosis of the cuneiform bones, and only one study has reported a case of aseptic osteonecrosis of the lateral cuneiform bone. This report aims to present a case of symptomatic aseptic osteonecrosis of the lateral cuneiform and proximal epiphysis of the third metatarsal bones that required surgical treatment following failure of the conservative treatment with favorable short-term clinical outcomes. A 16-year-old girl, an elite kendo player, was referred to our department for bilateral aseptic osteonecrosis of the lateral cuneiform and proximal epiphysis of the third metatarsal bones. She had been treated conservatively at an orthopaedic clinic for about five years while continuing to practice kendo. Her chief complaint was left foot pain during kendo that prevented her performance of kendo. Tenderness of the left third Lisfranc joint was identified, and computed tomography and magnetic resonance imaging findings suggested the bilateral aseptic osteonecrosis of the lateral cuneiform and proximal epiphysis of the third metatarsal bones. Arthrodesis of the left third Lisfranc joint was performed using a locking plate. She was able to return to playing kendo at five months after surgery. At the 20-month follow-up examination, postoperative patient-reported outcome measures were excellent and she was satisfied with the surgical outcomes. We herein firstly reported a case of symptomatic aseptic osteonecrosis of the lateral cuneiform and proximal epiphysis of the third metatarsal bones who underwent arthrodesis of the third Lisfranc joint after failure of the conservative treatment. The patient showed favorable short-term clinical outcomes. When aseptic osteonecrosis of the cuneiform bone develops in young athletes, surgical treatment may be recommended when conservative treatment failed. Clinical trial number: Not applicable.