Isolated first naviculocuneiform joint coalition.
ABSTRACT 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.
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Article: Calcaneonavicular coalition[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
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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 20(2):321-32; quiz 526-7, 532. · 2.73 Impact Factor
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ABSTRACT: We examined seven patients with tarsal tunnel syndrome in one foot caused by talocalcaneal coalition and a ganglion. We excised the coalition and the ganglion in six of them. All the patients had pain, sensory disturbance in the sole, and a positive Tinel's sign. Older patients with a long history showed atrophy and weakness of the plantar muscles. Talocalcaneal coalition can be diagnosed on a plain lateral radiograph and an anteroposterior radiograph externally rotated 20 degrees, and confirmed by CT. MRI is also useful for diagnosis. The coalitions were medial, and the ganglion had developed from the incomplete part of the coalition; it was multilocular in some patients. After resection, there was early pain relief but sensory disturbances and Tinel's sign persisted. The postoperative results were excellent in one patient, good in four and fair in one.The Bone & Joint Journal 02/1998; 80(1):130-3. DOI:10.1302/0301-620X.80B1.8224 · 2.80 Impact Factor