Imaging Analysis Report

I. Imaging Findings

On the X-ray of the dorsal-medial midfoot region of the right foot, there is an additional bone fragment (or osseous separation) near the medial cuneiform. This fragment displays a clear, well-defined cortical margin, with no obvious fracture line or sharp cortical disruption noted. No significant swelling of the adjacent soft tissue is observed; however, given the patient’s slight pain and swelling, further clinical evaluation is recommended.

II. Potential Diagnoses

• 1. Bipartite Medial Cuneiform
  A clearly defined accessory or bipartite bone in this area, with a mature cortical structure, suggests a congenital or developmental variation. Most such bipartite or accessory bones are asymptomatic but may cause pain if subject to local mechanical irritation or trauma.
• 2. Incomplete Fracture of the Medial Cuneiform
  Although typical fracture signs are not evident on the X-ray, an incomplete or occult fracture cannot be completely ruled out if there is a history of trauma, persistent pain, or changes in bone structure.
• 3. Other Accessory Bones (e.g., Accessory Navicular)
  Accessory bones or abnormal ossification centers are common in the foot region. Clinical correlation and imaging characteristics are necessary to differentiate if an accessory bone is located differently or has an atypical shape.

III. Most Likely Final Diagnosis

Considering the patient’s age (15 years), the location of the accessory bone fragment near the medial cuneiform, along with its mature cortical structure and long-standing symptoms, the most likely diagnosis is: Bipartite Medial Cuneiform with Local Symptoms.

If the patient reports significant pain or if imaging findings remain unclear, further CT or MRI could be considered to evaluate bone and soft tissue conditions and rule out other occult fractures or pathologies.

IV. Treatment Plan and Rehabilitation

1. Conservative Treatment and Recommendations:

• Reduced Weight-Bearing and Rest: During acute or more severe symptoms, activities with high impact such as running or jumping should be limited. Physical therapy or temporary bracing may be used if necessary.
• Anti-inflammatory and Analgesic Medication: Under medical guidance, non-steroidal anti-inflammatory drugs (NSAIDs) or topical treatments may help alleviate local pain and inflammation.
• Shoe Inserts or Footwear Adjustment: Select footwear with good arch support or consider custom orthotic insoles to reduce stress on the medial side of the foot.

2. Physical Therapy and Rehabilitation Exercises:

• Acute Phase (Weeks 1–2):
  Focus on reduced load and rest. Gentle foot exercises can be performed, such as ankle dorsiflexion and plantarflexion, and toe-gripping exercises to maintain joint mobility.
• Transition Phase (Weeks 3–4):
  As pain subsides, gradually introduce low-load lower limb strengthening exercises like seated heel raises or resistance-based plantarflexion in a seated position. Hydrotherapy or balance training can be added as appropriate.
• Rehabilitation Phase (After 4 Weeks):
  Once pain is largely resolved and joint mobility is good, training volume can be gradually increased according to the FITT-VP principle (Frequency, Intensity, Time, Type, and Progression), e.g., 3–4 times per week, 20–30 minutes per session at moderate intensity, without exacerbating pain. Progress from static balance (double-leg support) to dynamic single-leg support, eventually reintroducing light jogging or cycling.
• Principle of Exercise Progression:
  Start with small ranges of motion and fewer repetitions, gradually increasing movement amplitude, repetition counts, or resistance. Continuously monitor for foot pain or discomfort; if symptoms recur, reduce the intensity accordingly.

3. Surgical Indication:

• If conservative management (including rest, bracing, and physical therapy) fails to relieve persistent pain that significantly impacts functional activities, surgical intervention may be considered. However, surgery is rarely required for a bipartite medial cuneiform.

4. Special Considerations:

• In cases of abnormal foot arch structure or coexisting plantar fascia issues, strengthening the muscles in the foot and plantar fascia stretching may help reduce recurrence in later stages.
• Schedule regular follow-up appointments to assess changes in foot skeletal structure and soft tissue, and adjust the rehabilitation plan as necessary.