Calcaneotalar coalition and Talonavicular OA

Coalitions

Description of patient (type of occupation, indication of age, intensity of sport):

32 year old healthy female, officeworker.

History and previous treatment:

Since 1 year right foot pain. No pain before, no trauma. Due to severe pain medial and posterior treatment done with anti-inflammatories and physio for clinical diagnosis of posterior tibialis tendinitis. Because of no improvement imaging done.

Current complaints:

Pain medial side of the foot in height of sustentaculum tali. Electric sensations. Pain is not going away.

Physical examination:

Tenderness and pain over right medial hindfoot. Ankle ROM normal. no malalignment.

Radiology:

[Picture 1]
X-ray shows coalition calcaneotalar.

[Picture 2]
MRI shows calcaneotalar coalition with inflammation signal in hindfoot and cystic changes in naviculare without marrow edema.

[Picture 3, 4 + 5]
CT shows calcaneotalar coalition and multiple cysts in naviculare bone.

Images:

Case summary:

Symptomatic calcaneotalar coalition and asymptomatic talonavicular OA.

Question(s) to this case:

Which treatment is recommended:
- conservative?
- subtalar fusion?
- subtalar fusion and fusion of talonavicular joint?
- triple arthrodesis?

Expert:

Her complaints are:"Pain medial side of the foot in height of sustentaculum tali. Electric sensations. Pain is not going away." Therefor the patients symptoms come from the coalition and not from the talonavicular "overuse". Talar beaking is often seem in talocalcaneal coalitions. They are most often asymptomatic.
I recommend to perform a subtalar arthroscopic fusion only. Explain to the patient that if she becomes symptomatic over the talonavicular joint , then later you can perform talonavicular fusion if needed.

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