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.
- SourceAvailable from: Vassilios S Nikolaou
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 16(1):70-74. · 0.18 Impact Factor
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ABSTRACT: Tarsal coalitions between the navicular and the cuneiforms occur infrequently when compared with the more common talocalcaneal and calcaneonavicular coalitions. Isolated cases of navicular-medial cuneiform coalitions have only rarely been reported; however, the diagnosis is likely underrecognized. Conservative management should be pursued initially for symptomatic patients, followed by surgical options for unresponsive cases. The few reports available recommend treatment with navicular-medial cuneiform fusions, but long-term follow-up is not available to assess outcome and it remains unclear whether an isolated arthrodesis of the navicular-medial cuneiform joint will in turn lead to differing biomechanics of adjacent joints. We report a case of a patient with an isolated navicular-medial cuneiform coalition, treated with resection and free-fat interposition rather than arthrodesis. To our knowledge, this is the first case of a navicular-medial cuneiform coalition reported in a patient of North American ancestry. At 2 years postoperatively, she is pain-free with all activities and has full range of motion of her ankle and subtalar joints, and full mobility at the navicular-medial cuneiform joint. This unique method provided a successful solution to this difficult situation.Journal of pediatric orthopedics 12/2011; 31(8):e85-8. · 1.23 Impact Factor
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ABSTRACT: Isolated tarsometatarsal coalitions are extremely rare, and the previous 5 documented cases involved the first and third metatarsocuneiform joints. We report the case of a 69-year-old female with symptomatic fifth metatarsocuboid coalition associated with ipsilateral varus-type ankle osteoarthritis and instability. The patient was successfully treated by arthrodesis of the fifth metatarsocuboid joint, resection of the hypertrophied tuberosity of the fifth metatarsal, advancement of the peroneus brevis tendon, opening wedge distal tibial osteotomy, and calcaneal displacement osteotomy. After 1 year, 6 months, she was able to walk well, although she complained of minor discomfort under the fifth metatarsal base, which resolved with the use of protective padding. Radiographs at this stage confirmed consolidation of both the arthrodesis and the osteotomy sites. Although isolated fifth metatarsocuboid coalition is less likely to be encountered than other tarsal coalitions, it can sometimes be painful enough to necessitate surgery.The Journal of foot and ankle surgery: official publication of the American College of Foot and Ankle Surgeons 08/2014;