Medical Analysis Report

I. Imaging Findings

Based on the patient’s MRI examination (considering the sagittal and axial views provided), the following key features are noted:

• In the medial aspect of the tarsal bones, the cuneiform region shows a “bipartite” morphology, with the medial cuneiform separated into an upper and lower bony segment connected by fibrocartilage or cartilage, rather than a complete osseous union.
• On the sagittal view, an “E sign” (joint space shaped like the letter “E”) can be observed, suggesting a stable or semi-stable fibrocartilaginous connection between the upper and lower segments of the medial cuneiform.
• No obvious fracture line or fracture fragments; trabecular continuity is largely preserved, with mild bone marrow edema (possibly related to increased local stress and soft tissue reactions post-trauma).
• Surrounding joint structures are relatively intact, with no clear signs of tendon or ligament rupture.

II. Possible Diagnoses

1. Bipartite Medial Cuneiform (BMC)
   • Features: Often caused by two primary ossification centers failing to fuse, resulting in an upper and lower portion connected by fibrocartilage or cartilage. Frequently a congenital variant, usually asymptomatic; however, it may become painful if trauma or excessive loading occurs.
   • Imaging Characteristics: On the sagittal view, it often presents an “E-shaped” joint space (“E sign”); the edges of the upper and lower segments are smooth and well-defined, without a clear fracture line.
2. Medial Cuneiform Fracture
   • Features: Typically caused by trauma, characteristically displaying irregular fracture lines and fragment displacement. Anterior-posterior separation is more common (unlike the superior-inferior segmentation seen in BMC).
   • Imaging Characteristics: Fracture sites may show clear cortical discontinuity and sharper, irregular edges, often accompanied by local soft tissue swelling.

Based on the imaging findings in this case and supporting literature, congenital bipartite medial cuneiform aligns better with the observed features, especially the smooth contours of the bony segments and the notable “E sign.”

III. Final Diagnosis

Taking into account the patient’s age, symptoms (mild pain, limited but not disabling functional restriction), history of blunt trauma, imaging results, and lack of significant fracture displacement, the most likely diagnosis is: Bipartite Medial Cuneiform (BMC).

Although there is a history of trauma, the imaging does not indicate typical medial cuneiform fracture characteristics. Bipartite medial cuneiform may become symptomatic due to trauma or heavy loads, suggesting that current symptoms are more likely a post-traumatic exacerbation of a congenital BMC.

IV. Treatment Plan and Rehabilitation

Given the patient’s mild symptoms and no significant functional impairment, the following management and rehabilitation strategies are recommended:

1. Conservative Treatment
   • Short-term reduction of high-load or high-impact activities to avoid worsening inflammation at the cartilage junction.
   • Use arch supports or custom foot orthotics to maintain proper foot alignment and reduce local stress.
   • If pain is severe, under medical supervision, consider NSAIDs (non-steroidal anti-inflammatory drugs) or local corticosteroid injections to reduce inflammation.
   • A short-term ankle-foot brace or elastic bandage may be used to provide stable support during the acute phase.
2. Rehabilitation Training Recommendations (FITT-VP Principle)
   • Frequency: 3-4 sessions of rehabilitation exercises per week are advised, allowing 1-2 days of rest between sessions for adequate recovery.
   • Intensity: Begin with low-intensity exercises, such as active foot and ankle movements and light lower extremity strengthening. Avoid prolonged weight-bearing or high-impact activities.
   • Time: Each session should last approximately 20-30 minutes, increasing gradually according to the patient’s tolerance.
   • Type: May include seated ankle exercises (plantar flexion, dorsiflexion), foot-strengthening exercises with resistance bands (see examples below), and lower-limb core stability drills (like seated or standing balance training).
   • Progression: As pain subsides and foot strength and stability improve, exercises can gradually incorporate greater weight-bearing or longer durations. Pain and discomfort should be monitored, and the training load adjusted as necessary.
   • Example: Provided there is no significant pain, each session can include:
     • Ankle circles: 10-15 rotations clockwise and counterclockwise
     • Plantar flexion/dorsiflexion with a resistance band: 8-10 repetitions per set, for 2-3 sets
     • Single-leg standing (as tolerated): maintain for 10 seconds, repeat 5-8 times, with support from a wall or stable object if needed
3. Surgical Intervention
   • Considered only if symptoms are recurrent or significantly affect function and conservative treatments fail (e.g., cartilage rupture or persistent pain).
   • Potential procedures include fusion or excision of one fragment, but careful evaluation of local biomechanics is necessary.

Special Note: As the patient is older, bone quality (e.g., osteoporosis) should be evaluated. Gradual progression in strengthening and weight-bearing exercises is essential to avoid excessive stress concentration.

Disclaimer: This report is based solely on current examinations and available information. It does not replace in-person consultation or professional medical advice. If you have any concerns or your symptoms worsen, please seek medical attention or further evaluation promptly.