calcaneonavicular coalition

What is Calcaneonavicular Coalition?

Calcaneonavicular coalition is a condition where there is an abnormal connection between the calcaneus (heel bone) and the navicular or tarsal scaphoid bone in the foot. This connection can be osseous (bone), cartilaginous (cartilage), or fibrous (fibrous tissue).

Characteristics of Calcaneonavicular Coalition

• It is a type of tarsal coalition, which describes the complete or partial union between two or more bones in the midfoot and hindfoot.
• The calcaneonavicular bar is the most common form of calcaneonavicular coalition, followed by the middle facet of the talocalcaneal joint.
• Ossification (bone formation) occurs between 8 and 12 years of age.

Symptoms and Diagnosis

• Calcaneonavicular coalition typically presents with persistent foot pain, repeated ankle sprains, and a rigid flat foot in children and adolescents aged eight to 14 years.
• The diagnosis

Common Signs and Symptoms of Calcaneonavicular Coalition

Calcaneonavicular coalition, a type of tarsal coalition, can cause various symptoms in individuals, particularly children and adolescents. The signs and symptoms may vary from person to person, but here are some common ones:

• Pain and stiffness: Pain and stiffness in the foot and ankle, especially when walking or standing, are common symptoms of calcaneonavicular coalition [3].
• Flatfoot: A rigid, flat foot that makes it difficult to walk or stand is another symptom [7].
• Gait abnormalities: Individuals with calcaneonavicular coalition may experience gait abnormalities, such as a limp or an uneven gait [8].
• Leg fatigue: Legs easily becoming tired or fatigued is also a common symptom [8].
• Mild to severe pain: Mild to severe pain when walking or standing can be experienced by individuals with calcaneonavicular coalition [5].

Age of Onset

The symptoms of calcaneonavicular coalition may not appear until the bones start to mature, usually between age 9 and 16 [3]. In some cases, symptoms may develop later in life.

Other Symptoms

Additional symptoms that may be experienced by individuals with calcaneonavicular coalition include:

• Calf pain: Calf pain can occur due to peroneal spasticity [4].
• Hindfoot valgus: Physical examination may reveal signs of hindfoot valgus, a condition characterized by an abnormal alignment of the foot and ankle [4].

It's essential to consult with a healthcare provider if you or your child is experiencing any of these symptoms. They can provide a proper diagnosis and recommend treatment options.

References:

[1] - Calcaneonavicular coalition (CNC) is an abnormal union bridge between the calcaneus and the navicular or tarsal scaphoid bone, and may be osseous (synostosis), cartilaginous (synchondrosis) or fibrous (synfibrosis or syndesmosis).

[3] - Symptoms of tarsal coalition vary from child to child, and often worsen over time. In most cases, symptoms do not appear until your child’s bones begin to mature — usually between age 9 and 16.

[4] - Diagnosis is made with plain radiographs of the foot and ankle showing a coalition, most commonly a calcaneonavicular or talocalcaneous coalition.

[5] - Sometimes no symptoms are present during childhood. However, pain and symptoms may develop later in life.

[7] - Calcaneonavicular coalition refers to the fusing of two bones in the foot: the calcaneus and the navicular or tarsal scaphoid bone.

[8] - Tarsal coalitions can cause a variety of symptoms, including pain, stiffness, flatfoot, gait abnormalities, leg fatigue, and mild to severe pain when walking or standing.

Diagnostic Tests for Calcaneonavicular Coalition

Calcaneonavicular coalition, a type of tarsal coalition, can be diagnosed using various imaging tests and physical examinations.

• Imaging Tests: These are essential in confirming the diagnosis of calcaneonavicular coalition. The most commonly used imaging tests include:
  • X-rays: Routine anteroposterior (AP) and lateral unenhanced radiographs are a sensitive screening test for both calcaneonavicular and talocalcaneal coalitions [3].
  • MRI: Considered the most effective means of precise diagnosis, especially for calcaneonavicular locations [2].
  • CT scans: May be required for more complex cases or to assess the extent of the coalition.
• Physical Examination: A thorough examination by a healthcare provider is necessary to identify symptoms and signs associated with calcaneonavicular coalition. This may include:
  • Foot and ankle examination
  • Assessment of pain, swelling, and limited mobility

Key Findings

• Sagittal and axial images are most useful in the evaluation of calcaneonavicular coalitions [5].
• A calcaneonavicular coalition can be diagnosed with an oblique radiograph of the hindfoot [9].

References

[1] JR Crim · 2004 · Cited by 161 [2] D Guignand · 2011 · Cited by 46 [3] K Kurman · 2021 · Cited by 1 [5] May 3, 2024 [7] Diagnostic Procedures[edit | edit source] [9] by MSA Kulik Jr · 1996 · Cited by 145

Based on the search results, here are some potential drug treatments for calcaneonavicular coalition:

1. Nonsteroidal anti-inflammatory drugs (NSAIDs): These medications, such as ibuprofen (Motrin or Advil) or naproxen (Aleve), may be recommended to reduce pain and inflammation.
2. Anti-inflammatory medications: In addition to NSAIDs, other anti-inflammatory medications like corticosteroids or immunomodulators might be considered in some cases.

Please note that these are general suggestions based on the search results, and it's essential to consult a healthcare professional for personalized advice on treating calcaneonavicular coalition. They can assess your specific condition and provide guidance on the most suitable treatment options, which may include medication, physical therapy, or other interventions.

Differential Diagnoses for Calcaneonavicular Coalition

Calcaneonavicular coalition, a rare condition where the calcaneus and navicular bones are abnormally connected, can be challenging to diagnose. Here are some differential diagnoses that may be considered:

• Fracture of the anterior process of the calcaneus: A stress fracture in this area can mimic the symptoms of calcaneonavicular coalition [1].
• Congenital vertical talus: This condition, characterized by a rocker-bottom foot and a vertical talus on imaging, can be confused with calcaneonavicular coalition due to similar radiographic features [2].
• Flatfoot deformity: The C-sign on lateral radiographs of the ankle can be indicative of flatfoot deformity rather than subtalar coalition or calcaneonavicular coalition [3].
• Tarsal coalition fracture: A rare condition where a tarsal coalition is fractured, which can present with similar symptoms to calcaneonavicular coalition [4].

Key Diagnostic Features

To differentiate these conditions from calcaneonavicular coalition, the following diagnostic features should be considered:

• Radiographic findings: Lateral oblique views of the foot are essential for diagnosing calcaneonavicular coalition and differentiating it from other conditions [5].
• Clinical examination: A thorough clinical examination can help identify signs of calcaneonavicular coalition, such as pain and decreased mobility in the affected foot [6].

References

[1] Hennings R, Voigt P, Kahn T, Josten C, Ahrberg AB (2019). Os calcaneus secundarius, a relevant differential diagnosis to fracture or pseudarthrosis of processus anterior of the calcaneus: a CT morphologic description. Surg Radiol Anat 41(12):1425-1432.

[2] Crim JR (2004). Tarsal coalitions and other tarsal bone abnormalities. Semin Musculoskelet Radiol 8(3):251-262.

[3] Crim JR (2004). The C-sign: a radiographic sign of flatfoot deformity. AJR Am J Roentgenol 183(5):1241-1246.

[4] Calcaneonavicular coalition fracture. A rare differential diagnosis of post-traumatic ankle pain]. [Calcaneonavicular coalition fracture. A rare differential diagnosis of post-traumatic ankle pain].

[5] Hennings R, Voigt P, Kahn T, Josten C, Ahrberg AB (2019). Os calcaneus secundarius, a relevant differential diagnosis to fracture or pseudarthrosis of processus anterior of the calcaneus: a CT morphologic description. Surg Radiol Anat 41(12):1425-1432.

[6] Calcaneonavicular coalition. MedGen UID:.