Buschke Disease is a very rare osteochondrosis of one of the cuneiform bones. Most of the literature on this condition consists of case reports (see table below of cases). Average age of onset is around 5 years with boys being much more affected than girls. The medial cuneiform is the most commonly affected bone. Bilateral involvement is more common than unilateral. The most common clinical presentation is pain and limping and the bone is tender to palpation. On x-ray there are a variety of findings, including a bone that is more dense and smaller in size for the age with some having an abnormal shape.
Differential: Stress fracture | Ewing’s Sarcoma | Dorsal Midfoot Interosseous Compression Syndrome | Symptomatic bipartite medial cuneiform | Overuse syndrome at base of second metatarsal | Hypermobile intercuneiform joint (First metatarsocuneiform instability)
Management: The condition appears to be self limiting and none of the cases reported noted any long term negative sequalae. The pain can be managed with NSAID’s and activity limitation. Some may benefit from foot support or a below knee walking cast for 4 to 6 weeks.
One author considers it a normal variant not needing treatment.
Cases Reported in the Literature:
| Publication | Sex | Age | Bone(s) | Clinical Features | X-ray | Management |
|---|---|---|---|---|---|---|
| Buchman (1933) | M | 6.5 | Left foot; medial cuneiform | Pain; limp; tender | Irregular outline to bone; deformed; smaller bone than normal | Strapping |
| M | 6.5 | Right foot; medial cuneiform | Nil reported | Irregular outline to bone; Irregular calcification | Nil | |
| Haboush (1933) | M | 4.5 | Both feet; medial cuneiform | Pain; limp; tender | Sclerotic border to bone; focal areas of radiolucency; bone larger than normal | Not reported |
| Meilstrup (1947) | M | 4 | Both feet; medial cuneiform | Pain; tender | Increased bone density; bone smaller than normal | Not reported |
| O'Donoghue et al (1948) | M | 3 | Both feet; medial cuneiform | Pain; limp | Bone fragmentation and 'moth eaten' appearance | Foot supports |
| Hicks (1953) | F | 5 | Left foot; intermediate cuneiform | Pain; limp; tender | Increased bone density; bone smaller than normal | Casting |
| Smyth (1957) | M | 5 | Both feet; intermediate cuneiform | Limp; swelling; varus deformity of left foot | Irregular outline to bone; increased bone density; bone smaller than normal | Not reported |
| Leeson & Weiner (1985) | M | 6 | Right foot; intermediate cuneiform | Pain; limp; tender | Irregular outline to bone; increased bone density | NSAID's; limited activity |
| M | 5 | Right foot; medial cuneiform | Intermittent pain; tender | Increased bone density | NSAID's; limited activity | |
| Mubarak (1992) | M | 2.5 | Both feet; lateral cuneiform | Pain; limp; antalgic and out toe gait | Bone sclerosis; bone smaller than normal | Nil |
| Chew et al (1995) | F | 8 | Both feet; medial cuneiform | Pain at night | Irregular sclerosis of bone | Surgical drilling |
| Vaquero Martin et al (1999) | M | 6 | Both feet; medial cuneiform | Pain; toe walking; limited ankle dorsiflexion | Bone fragmentation; bone smaller; increased bone density | Foot supports |
| M | 4 | Both feet; medial cuneiform | Flat foot | Bone fragmentation; bone smaller; increased bone density | Nil | |
| M | 4 | Both feet; medial cuneiform | Flat foot | Bone fragmentation; bone smaller; increased bone density | Foot supports | |
| M | 6 | Both feet; medial cuneiform | In toe gait | Bone fragmentation; bone smaller; increased bone density | Nil | |
| Watmough et al (2003) | F | Left foot; intermediate cuneiform | Pain; tender | Avascular necrosis; decreased intensity on MRI | NSAID's; limited activity | |
| Kose et al (2009) | F | 4.8 | Rightt foot; intermediate cuneiform | Pain; limp; tender | Increased density; decreased intensity on MRI; irregular margins | NSAID's; limited activity |
| Garcia-Mata (2011) | M | 4.4 | Left foot; intermediate cuneiform | Pain; tender | Increased bone density; bone smaller than normal | Nil |
| Atbasi et al (2013) | M | 6.5 | Both feet; medial cuneiform | Pain; limp; tender | Increased density; decreased intensity on MRI; irregular margins | NSAID's; limited activity |
Note: ‘Buschke Disease’ is also a name given to Scleredema (not to be confused with Scleroderma). This is a progressive hardening and thickening of the skin named after Abraham Buschke.
Related Topics:
Lateral Cuneiform | Medial Cuneiform | Intermediate Cuneiform | Cuneiform Stress fracture | X-ray of the Cuneiforms
Other Osteochondroses:
Calcaneal Apophysitis | Diaz (Mouchet’s) Disease | Distal Tibial Epiphysitis | Freiberg’s Disease | Iselins Disease | Kohler’s Disease | Legg-Calve-Perthes Disease | Osgood-Schlatter Disease | Osteochondrosis of Os navicularis | Severs Disease | Thiemann’s Disease | Treves’ or Ilfeld’s Disease
External Links:
Osteochondrosis of the Cuneiform Bones (Buschke disease) (Podiatry Arena Discussion)
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