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Foot Ankle Int. 2014 May;35(5):489-95. doi: 10.1177/1071100714520696. Epub 2014 Jan 23.

Treatment of naviculo-first cuneiform coalition of the foot.

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  • 1Department of Orthopaedic Surgery, Asan Medical Center, College of Medicine, Ulsan University, Seoul, Korea.

Abstract

BACKGROUND:

Naviculo-first cuneiform coalition is a rare form of tarsal coalition with few reports. We therefore have analyzed its clinical features and the results of treatment.

METHODS:

We analyzed 36 feet in 28 patients diagnosed with naviculo-first cuneiform coalition from January 2003 to December 2010. The 28 patients were 10 males and 18 females, with 18 right and 18 left feet, including 8 patients with bilateral coalition. The location and morphological pattern of naviculo-first cuneiform coalition were analyzed radiologically. Symptomatic patients initially received conservative management for 6 months. Six feet of 5 patients were treated operatively, 3 feet by curettage and 3 by fusion.

RESULTS:

Eighteen feet had symptoms, while 18 feet without symptoms were diagnosed incidentally. Mean patient age at diagnosis was 34.6 years (range, 10-68 years). The mean age at diagnosis of symptomatic patients was 29.6 years (range, 10-50 years). Coalitions were located mainly in the medioplantar area. There was no bony coalition. Computed tomography or magnetic resonance imaging showed a cystic pattern in 7 patients, an irregular pattern in 4, a combined pattern in 5, and a spur-forming pattern in 1. The mean American Orthopaedic Foot & Ankle Society scores at the last follow-up in patients treated conservatively and operatively were 95.3 (range, 87-100) and 83.5 (range, 70-95), respectively. Among the 5 operated patients, 3 patients (60%) complained of pain, including 2 who received curettage and 1 who developed a nonunion after attempted fusion.

CONCLUSION:

Conservative treatment should be considered over surgery in treating naviculo-first cuneiform coalition.

LEVEL OF EVIDENCE:

Level III, comparative case series.

KEYWORDS:

first naviculo–cuneiform coalition; naviculo–first cuneiform coalition; tarsal coalition

[PubMed - indexed for MEDLINE]
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