Talonavicular coalition. Objective gait analysis

Talonavicular Coalition as a Cause of Foot Pain

Tarsal coalitions have an incidence of 2% and are often underdiagnosed. These are considered to be one of the causes of chronic ankle and foot pain. Among all tarsal coalitions, the talonavicular type represents a rare and uncommon condition. The purpose of this article was to present the case of a 35-year-old male patient with a bilateral talonavicular coalition treated conservatively. A review of the literature was also performed to understand the management of this rare condition.

An incidental talonavicular coalition in a diabetic patient: a podiatric perspective

A tarsal coalition is a pathological union of two or more tarsal bones. The authors present an incidental finding of a unilateral talonavicular (TN) coalition that was overlooked in a 57-year-old diabetic female with signs and symptoms of peripheral neuropathy. This case highlights the clinical implications and important teaching points in recognising a TN coalition. This is particularly relevant for new, upcoming clinicians who may have never been exposed to this diagnostic rarity during clinical training.

Talonavicular synostosis with lateral ankle instability--A case report and review of the literature

Talonavicular coalition is a rare autosomal recessive congenital anomaly that is usually asymptomatic and detected incidentally on radiographs. It is associated with symphalangism, clinodactyly, a great toe that is shorter than the second toe, clubfoot, calcaneonavicular coalition, talocalcaneal coalition and a ball-and-socket ankle joint. The authors present a review of the literature and case report of a patient with complete osseous talonavicular coalition, talocalcaneal coalition and lateral ankle instability which was successfully treated with subtalar fusion and lateral ligament reconstruction.

Case reports: symptomatic bilateral talonavicular coalition

Congenital talonavicular coalition is reported less frequently than talocalcaneal or calcaneonavicular coalition and represent approximately 1% of all tarsal coalitions. Although reportedly transmitted as an autosomal-dominant disorder, tarsal coalition may be inherited as an autosomal-recessive trait. It has been associated with various orthopaedic anomalies, including symphalangism, clinodactyly, a great toe shorter than the second toe, clubfoot, calcaneonavicular coalition, talocalcaneal coalition, and a ball-and-socket ankle. Patients with talonavicular coalitions are usually asymptomatic and rarely undergo surgical treatment. We report the case of a 24-year-old woman with symptomatic bilateral talonavicular coalitions and previously unreported associated anomalies (nail hypoplasia and metatarsus primus elevatus) and review the relevant literature. The patient underwent surgery (calcaneocuboid joint distraction arthrodesis and a proximal plantar flexion osteotomy with a dorsal open wedge of the first metatarsal). At 1-year followup, she was pain-free with better alignment of both feet and showed radiographic consolidation of the arthrodesis. Although this condition is less likely to be clinically important than other tarsal fusions, it sometimes can be painful enough for the patient to undergo surgery.

Cavovarus foot deformity with multiple tarsal coalitions: functional and three-dimensional preoperative assessment

In rare instances, tarsal coalition leads to cavovarus foot deformity, although the pathologic mechanism leading to this deformity is not clear. This article reports a case of a 14-year-old boy presenting a severe cavovarus deformity of the right foot with talocalcaneal and calcaneonavicular coalitions, and a mild cavus deformity of the left foot with a single talocalcaneal coalition. Computed tomography and postoperative histologic analysis demonstrated a synostosis between talus and calcaneus and a fibrous calcaneonavicular coalition with partial ossification. Instrumented gait analysis revealed a limited range of ankle plantar flexion and increased external rotation of the ankle. Associated skeletal malformations including incomplete hemimelia of the forearm and scoliosis raised the possibility of a teratologic condition, but neurologic examination, spinal magnetic resonance imaging, and nerve conduction velocities were normal. The progressive ossification of combined coalitions during growth of the foot may have been one factor leading to this complex foot deformity. The fine-wire electromyogram showed normal tibialis anterior and posterior muscle activity. Small soft tissue tears in the sinus tarsi may have led to a mild reflexive increase of the muscle tone and tendon shortening, which pulled the forefoot into adduction and the heel into varus, and raised the medial arch. Mechanical alterations of the ankle appear secondary to the heel varus and to the progressive deformity of the talus. Three-dimensional computed tomography reconstruction and gait analysis appeared to be helpful additional parameters to understanding the pathomechanics of this complex foot deformity and for preoperative planning of triple arthrodesis.

Effects of tarsal coalition resection on dynamic plantar pressures and electromyography of lower extremity muscles

The goal of this study was to evaluate kinetic abnormalities in feet after tarsal coalition resection using plantar pressure measurements and electromyography of 4 muscle groups in the lower limb. Eleven subjects (14 feet) with tarsal coalition (3 feet with calcaneocuboid, 6 feet with calcaneonavicular, and 5 feet with talocalcaneal) underwent coalition excision. Patients ranged in age from 9 to 17 years, and mean follow-up was 20 months. Two feet underwent subsequent subtalar fusion and 1 had a triple arthrodesis. Plantar pressure and electromyography measurements were compared with data taken from 68 normal (control) subjects between the ages of 6 to 16 years. Feet with tarsal coalition showed significant differences in the midfoot region, with increases in contact area (40.36 cm2 +/- 14.7 vs 18.02 cm2 +/- 8.0, P < .001), loading (5.63 N/cm2 sec +/- 3.4 vs 1.83 N/cm2 sec +/- 0.9, P < .001) and peak pressure (13.38 N/cm2 +/- 5.8, 6.81 N/cm2 +/- 2.8, P = .01). Tarsal coalition feet also displayed reduced peak pressure and loading at the region of the fifth metatarsal head as compared with uninvolved feet (P < .05). Electromyography measurements were also performed on both the affected and unaffected feet of 9 subjects who had undergone resection of their coalition. These measurements revealed nearly consistent abnormal activity in the peroneal, gastrocnemius, and soleus muscles on both the surgically operated foot and the contralateral side, including either prolonged monophasic activity or biphasic activity. These findings suggest that although resection of coalition may have relieved symptoms of discomfort, it did not restore normal foot alignment or muscular balance.