Treatment of Naviculo–First Cuneiform Coalition of the Foot

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.