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The rare cuboid-navicular coalition presenting as chronic foot pain.

Awan O, Graham JA - Case Rep Radiol (2015)

Bottom Line: The purpose in presenting this case is to demonstrate that cuboid-navicular coalition can be associated with chronic unremitting pain, as in our patient.Furthermore, from an imaging standpoint, radiographic findings are often subtle and radiologists cannot rely on indirect signs such as talar beak in clinching the diagnosis of cuboid-navicular coalition.Instead, abnormal articulation between the cuboid and navicular must be sought.

View Article: PubMed Central - PubMed

Affiliation: Radiology, Geisel School of Medicine, One Medical Center Drive, Lebanon, NH 03756, USA ; Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756, USA ; Radiology and Imaging Informatics, University of Maryland School of Medicine, 22 South Greene Street, Baltimore, MD 21201, USA.

ABSTRACT
Tarsal coalitions are relatively rare diagnoses affecting adolescent patients that typically present with progressive foot pain. Cuboid-navicular coalition, a type of tarsal coalition, is extremely rare with less than 10 reported cases to date. Most prevailing theories reported have described this specific type of coalition as asymptomatic except at specific moments of stress and exercise. The purpose in presenting this case is to demonstrate that cuboid-navicular coalition can be associated with chronic unremitting pain, as in our patient. We present a case of cuboid-navicular fibrocartilaginous coalition in an adolescent patient presenting with chronic foot pain. Furthermore, from an imaging standpoint, radiographic findings are often subtle and radiologists cannot rely on indirect signs such as talar beak in clinching the diagnosis of cuboid-navicular coalition. Instead, abnormal articulation between the cuboid and navicular must be sought.

No MeSH data available.


Related in: MedlinePlus

(a)-(b) Coronal short tau inversion recovery (STIR) unenhanced MR images of the right foot in a 17-year-old male with cuboid-navicular coalition demonstrate marrow edema and cystic change in the cuboid (arrows, (a)) as well as bone marrow edema in the navicular (arrows, (b)).
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fig3: (a)-(b) Coronal short tau inversion recovery (STIR) unenhanced MR images of the right foot in a 17-year-old male with cuboid-navicular coalition demonstrate marrow edema and cystic change in the cuboid (arrows, (a)) as well as bone marrow edema in the navicular (arrows, (b)).

Mentions: The orthopedic surgeon decided to order radiographs of the foot that initially were read as negative for fracture or any significant abnormality by the radiologist. In retrospect, the posterior medial aspect of the cuboid articulated abnormally with the plantar lateral aspect of the navicular (Figure 1). Importantly, no talar beak was visualized on radiography. The orthopedic surgeon then ordered magnetic resonance imaging (MRI) of the right foot without intravenous contrast to further elucidate the etiology of the patient's symptoms. MRI revealed abnormal articulation between the cuboid and navicular as well as marrow edema on both sides of the coalition with cystic change along the cuboid (Figures 2(a), 2(b), 3(a), 3(b), and 4), consistent with fibrocartilaginous coalition as no osseous connection was seen between the cuboid and navicular. The patient was treated conservatively with physical therapy that helped for three months and is scheduled to receive a cortisone injection into the coalition if necessary for further alleviation of symptoms. However, to date, the patient has not reported pain recurrence and cortisone injection has been deferred until the patient presents again with pain. The orthopedic surgeon never ordered computed tomography (CT) examination since surgical planning was not needed in this case. No further imaging has been performed on this patient after his baseline MRI foot examination.


The rare cuboid-navicular coalition presenting as chronic foot pain.

Awan O, Graham JA - Case Rep Radiol (2015)

(a)-(b) Coronal short tau inversion recovery (STIR) unenhanced MR images of the right foot in a 17-year-old male with cuboid-navicular coalition demonstrate marrow edema and cystic change in the cuboid (arrows, (a)) as well as bone marrow edema in the navicular (arrows, (b)).
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4321666&req=5

fig3: (a)-(b) Coronal short tau inversion recovery (STIR) unenhanced MR images of the right foot in a 17-year-old male with cuboid-navicular coalition demonstrate marrow edema and cystic change in the cuboid (arrows, (a)) as well as bone marrow edema in the navicular (arrows, (b)).
Mentions: The orthopedic surgeon decided to order radiographs of the foot that initially were read as negative for fracture or any significant abnormality by the radiologist. In retrospect, the posterior medial aspect of the cuboid articulated abnormally with the plantar lateral aspect of the navicular (Figure 1). Importantly, no talar beak was visualized on radiography. The orthopedic surgeon then ordered magnetic resonance imaging (MRI) of the right foot without intravenous contrast to further elucidate the etiology of the patient's symptoms. MRI revealed abnormal articulation between the cuboid and navicular as well as marrow edema on both sides of the coalition with cystic change along the cuboid (Figures 2(a), 2(b), 3(a), 3(b), and 4), consistent with fibrocartilaginous coalition as no osseous connection was seen between the cuboid and navicular. The patient was treated conservatively with physical therapy that helped for three months and is scheduled to receive a cortisone injection into the coalition if necessary for further alleviation of symptoms. However, to date, the patient has not reported pain recurrence and cortisone injection has been deferred until the patient presents again with pain. The orthopedic surgeon never ordered computed tomography (CT) examination since surgical planning was not needed in this case. No further imaging has been performed on this patient after his baseline MRI foot examination.

Bottom Line: The purpose in presenting this case is to demonstrate that cuboid-navicular coalition can be associated with chronic unremitting pain, as in our patient.Furthermore, from an imaging standpoint, radiographic findings are often subtle and radiologists cannot rely on indirect signs such as talar beak in clinching the diagnosis of cuboid-navicular coalition.Instead, abnormal articulation between the cuboid and navicular must be sought.

View Article: PubMed Central - PubMed

Affiliation: Radiology, Geisel School of Medicine, One Medical Center Drive, Lebanon, NH 03756, USA ; Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756, USA ; Radiology and Imaging Informatics, University of Maryland School of Medicine, 22 South Greene Street, Baltimore, MD 21201, USA.

ABSTRACT
Tarsal coalitions are relatively rare diagnoses affecting adolescent patients that typically present with progressive foot pain. Cuboid-navicular coalition, a type of tarsal coalition, is extremely rare with less than 10 reported cases to date. Most prevailing theories reported have described this specific type of coalition as asymptomatic except at specific moments of stress and exercise. The purpose in presenting this case is to demonstrate that cuboid-navicular coalition can be associated with chronic unremitting pain, as in our patient. We present a case of cuboid-navicular fibrocartilaginous coalition in an adolescent patient presenting with chronic foot pain. Furthermore, from an imaging standpoint, radiographic findings are often subtle and radiologists cannot rely on indirect signs such as talar beak in clinching the diagnosis of cuboid-navicular coalition. Instead, abnormal articulation between the cuboid and navicular must be sought.

No MeSH data available.


Related in: MedlinePlus