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Tarsal coalitions are an uncommon pathology, representing approximately a 1% occurrence in the general population, and most commonly diagnosed in the younger population. Coalitions between the cuboid and navicular are especially rare. In this case series, all patients were young (15-35 years of age), active patients with fibrous coalitions at the cuboid-navicular interface; 3 of the 4 patients related a past history of ankle sprains on the affected side. After conservative treatment was exhausted and a diagnostic injection was performed that eliminated the pain, surgical intervention was used that consisted of coalition resection and interposition of an adipose graft harvested from the lower leg. All patients were able to return to their previous level of activity and remain pain-free at the surgical site. Our series of 4 cases of this coalition suggests that, although rare, cuboid-navicular coalition should be included in the differential diagnosis when patients present with persistent foot pain and suspicion of tarsal coalition is high. We also demonstrate that surgical resection of this coalition with an interpositional adipose graft provides excellent results.
Arthroscopic resection of calcaneonavicular coalition/malunion via a modified sinus tarsi approach: An early case series.
Singh AK, Parsons SW. Foot Ankle Surg. 2012 Dec;18(4):266
Calcaneonavicular coalition represents abnormal coalescence between calcaneus and navicular bone. It is a congenital anomaly, sometimes becoming symptomatic in young adolescent. This is managed conservatively initially, failing which surgical excision, open or arthroscopic, is considered. We present our arthroscopic technique via a modified sinus tarsi approach, with early results in two adolescent and two young adult patients.
The patient is placed in a 45° "saggy" lateral position, and entry points for portals are marked around sinus tarsi area. The adequacy of resection is checked with image intensifier at the end of procedure. Patients complete subjective scoring forms, Manchester-Oxford Foot Questionnaire and Visual Analogue Scale, pre operatively and at follow-ups. Paired t test was performed to assess statistical significance.
The results of early follow-up of these patients have confirmed complete excision, non-recurrence and symptomatic improvement. The mean difference in MOXFQ scores pre and post surgery is 39.33, with a two-tailed p value of 0.0187. Similarly, the mean difference in VAS score is 5.67 with a two-tailed p value of 0.0034. These are statistically significant and confirm symptomatic improvement at an early follow-up.
The arthroscopic technique provides better access allowing wide excision and causes minimal soft tissue trauma leading to early recovery and mobilisation.