Isolated First Naviculocuneiform Joint Coalition
Department of Orthopaedic Surgery, Nara Medical University, Japan. Foot & Ankle International
(Impact Factor: 1.51).
11/1996; 17(10):635-40. DOI: 10.1177/107110079601701009
Clinical analysis was performed on 60 feet in 40 patients with isolated first naviculocuneiform coalitions. The most common symptom was a mild pain at the medioplantar site of the first naviculocuneiform joint. Fifteen feet (25%) were asymptomatic. Some cases had been treated erroneously as osteoarthritis or bony cyst before diagnosis. We divided coalitions morphologically into three patterns based on computed tomography findings: irregular, cystic, and combined pattern. Based on the mean age of each pattern, we hypothesized that initial irregular coalitions gradually develop into cystic and, finally, combined patterns. Considering the modest number of reported cases, this condition might easily be overlooked in many patients or may be related to ethnic characteristics. We suggest that the actual incidence of first naviculocunei-form coalitions should be investigated again.
Available from: Vassilios S Nikolaou
[Show abstract] [Hide abstract]
ABSTRACT: Tarsal coalition is a congenital condition, involving abnormal fusion between tarsal bones, often resulting in decreased mobility,
pain, and deformity leading to a rigid planovalgus foot . The most common sites of tarsal coalition reported in the literature
are the calcaneonavicular and the talocalcaneal areas. Clinical examination and three radiographic views of the foot, anteroposterior,
45° internal oblique and lateral, are often sufficient for the diagnosis of most calcaneonavicular coalitions. Nevertheless,
fibrous and many cases of cartilaginous coalitions cannot be identified with standard radiographic examination and further
investigation with CT and MRI is needed. Conservative treatment is the initial choice. Unfortunately, calcaneonavicular coalitions
usually respond poorly to conservative treatment. Surgery with excision of the bar that bridges the two bones gives good results
in 70 to almost 80% of the patients. Very rarely calcaneonavicular coalition gives symptoms during the third/fourth decade
of the life. In these cases it is possible that concomitant degenerative changes have been developed. Many authors believe
that triple arthrodesis is the initial treatment of choice for these patients as in the case presented.
La synostose du tarse est un état congénital, impliquant la fusion anormale entre les os du tarse souvent ayant pour résultat
une diminution de la mobilité, des douleurs et un défaut de la forme du pied, le tout menant à un pied rigide de planovalgus.
Les emplacements les plus communs de la synostose tarsienne, rapportés dans la littérature, sont les secteurs calcanéo-naviculaire
(calcanéo-scaphoïdienne) et talo-calcanéen (astragalo-calcanéenne). L’examen clinique et trois incidences radiographiques
du pied, antéro-postérieure, d’oblique à 45° latéral et interne, sont le plus souvent suffisants pour le diagnostic de la
plupart des synostoses calcanéo-naviculaires. Néanmoins, beaucoup de cas de synostoses fibreuses ou cartilagineuses ne peuvent
pas être identifiées avec l’examen radiographique standard et davantage de recherche avec le scanner et l’IRM est nécessaire.
Le traitement conservateur est le traitement initial de choix. Malheureusement, les synostoses calcanéo-naviculaires répondent
habituellement mal au traitement conservateur. La chirurgie avec l’excision de la barre qui jette un pont entre les deux os
donne de bons résultats dans 70 à presque 80% des patients. Très rarement la synostose calcanéo-naviculaire donne des symptômes
pendant la 3ème ou 4ème décennie de la vie. Dans ces cas il est très possible que des changements dégénératifs concomitants
aient été développés. Beaucoup d’auteurs croient que la triple arthrodèse est le traitement initial de choix pour ces patients,
comme dans le cas présenté.
European Journal of Orthopaedic Surgery & Traumatology 03/2005; 16(1):70-74. DOI:10.1007/s00590-005-0023-6 · 0.18 Impact Factor
[Show abstract] [Hide abstract]
ABSTRACT: Congenital tarsal coalition is a diagnosis that is often overlooked in young patients who first present with foot and ankle pain. Calcaneonavicular and talocalcaneal coalitions are encountered most frequently; fusion at other sites is much less common. Tarsal coalitions may be osseous, cartilaginous, or fibrous. Calcaneonavicular coalitions are readily detected on oblique radiographs. Radiographic confirmation of talocalcaneal coalition is more difficult than for fusion at other locations, although several secondary radiographic signs may indirectly suggest the diagnosis. Computed tomography (CT) and magnetic resonance (MR) imaging are invaluable for assessment of tarsal coalitions because they allow differentiation of osseous from nonosseous coalitions and because they depict the extent of joint involvement as well as secondary degenerative changes, features of vital importance in surgical planning. Short-inversion-time inversion recovery MR images may reveal bone marrow edema along the margins of the abnormal articulation, an important clue to the diagnosis. Moreover, CT or MR imaging may be required to confirm the diagnosis of talocalcaneal coalition when radiographic findings are equivocal. Because the diagnosis of tarsal coalition is often not entertained by the clinician ordering a CT or MR imaging examination, multiplanar imaging of the ankle and hindfoot is required.
Radiographics 01/2000; 20(2):321-32; quiz 526-7, 532. · 2.60 Impact Factor
[Show abstract] [Hide abstract]
ABSTRACT: A sprain of the Lisfranc joint during athletic activity may produce severe soft tissue injury to the extent that inadequate treatment delays an athlete's return to sports participation. The clinical appearance is benign other than pronation of the mid-foot reproducing the pain. Similarly, the radiographic evaluation of these low-energy injuries to the tarsometatarsal joint may vary along the spectrum of a sprain, a fracture, or a dislocation. Certain patterns of injury are associated with prolonged restriction from competition. Residual sequelae are uncommon with adequate treatment. Treatment rationale should be based on the degree of anatomy disruption, clinical findings, and radiographic evaluation. Computed tomography is an accurate method of demonstrating the extent of neuropathic changes but is an insensitive indicator of disease activity. Fractures and dislocations of the diabetic foot and ankle do not invariably lead to neuropathic arthropathy. An awareness of anatomic variants and of fracture patterns can facilitate the evaluation of midfoot pain in the limping child.
(C) Lippincott-Raven Publishers.
Current Opinion in Orthopaedics 05/1996; 7(3). DOI:10.1097/00001433-199606000-00003
Data provided are for informational purposes only. Although carefully collected, accuracy cannot be guaranteed. The impact factor represents a rough estimation of the journal's impact factor and does not reflect the actual current impact factor. Publisher conditions are provided by RoMEO. Differing provisions from the publisher's actual policy or licence agreement may be applicable.