Buschke disease (Osteochondrosis of the Cuneiform bones)

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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:

PublicationSexAgeBone(s)Clinical FeaturesX-rayManagement
Buchman (1933)M6.5Left foot; medial cuneiformPain; limp; tenderIrregular outline to bone; deformed; smaller bone than normalStrapping
M6.5Right foot; medial cuneiformNil reportedIrregular outline to bone; Irregular calcificationNil
Haboush (1933)M4.5Both feet; medial cuneiformPain; limp; tenderSclerotic border to bone; focal areas of radiolucency; bone larger than normalNot reported
Meilstrup (1947)M4Both feet; medial cuneiformPain; tenderIncreased bone density; bone smaller than normalNot reported
O'Donoghue et al (1948)M3Both feet; medial cuneiformPain; limpBone fragmentation and 'moth eaten' appearanceFoot supports
Hicks (1953)F5Left foot; intermediate cuneiformPain; limp; tenderIncreased bone density; bone smaller than normalCasting
Smyth (1957)M5Both feet; intermediate cuneiformLimp; swelling; varus deformity of left footIrregular outline to bone; increased bone density; bone smaller than normalNot reported
Leeson & Weiner (1985)M6Right foot; intermediate cuneiformPain; limp; tenderIrregular outline to bone; increased bone densityNSAID's; limited activity
M5Right foot; medial cuneiformIntermittent pain; tenderIncreased bone densityNSAID's; limited activity
Mubarak (1992)M2.5Both feet; lateral cuneiformPain; limp; antalgic and out toe gaitBone sclerosis; bone smaller than normalNil
Chew et al (1995)F8Both feet; medial cuneiformPain at nightIrregular sclerosis of boneSurgical drilling
Vaquero Martin et al (1999)M6Both feet; medial cuneiformPain; toe walking; limited ankle dorsiflexionBone fragmentation; bone smaller; increased bone densityFoot supports
M4Both feet; medial cuneiformFlat footBone fragmentation; bone smaller; increased bone densityNil
M4Both feet; medial cuneiformFlat footBone fragmentation; bone smaller; increased bone densityFoot supports
M6Both feet; medial cuneiformIn toe gaitBone fragmentation; bone smaller; increased bone densityNil
Watmough et al (2003)FLeft foot; intermediate cuneiformPain; tenderAvascular necrosis; decreased intensity on MRINSAID's; limited activity
Kose et al (2009)F4.8Rightt foot; intermediate cuneiformPain; limp; tenderIncreased density; decreased intensity on MRI; irregular marginsNSAID's; limited activity
Garcia-Mata (2011)M4.4Left foot; intermediate cuneiformPain; tenderIncreased bone density; bone smaller than normalNil
Atbasi et al (2013)M6.5Both feet; medial cuneiformPain; limp; tenderIncreased density; decreased intensity on MRI; irregular marginsNSAID'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)

Page last updated: Sep 6, 2017 @ 1:05 pm

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