title: Isolated navicular-medial cuneiform tarsal coalition revisited:  a case report.
abstract: Tarsal coalitions between the navicular and the cuneiforms occur infrequently when compared with the more common talocalcaneal and calcaneonavicular coalitions. Isolated cases of navicular-medial cuneiform coalitions have only rarely been reported; however, the diagnosis is likely underrecognized. Conservative management should be pursued initially for symptomatic patients, followed by surgical options for unresponsive cases. The few reports available recommend treatment with navicular-medial cuneiform fusions, but long-term follow-up is not available to assess outcome and it remains unclear whether an isolated arthrodesis of the navicular-medial cuneiform joint will in turn lead to differing biomechanics of adjacent joints. We report a case of a patient with an isolated navicular-medial cuneiform coalition, treated with resection and free-fat interposition rather than arthrodesis. To our knowledge, this is the first case of a navicular-medial cuneiform coalition reported in a patient of North American ancestry. At 2 years postoperatively, she is pain-free with all activities and has full range of motion of her ankle and subtalar joints, and full mobility at the navicular-medial cuneiform joint. This unique method provided a successful solution to this difficult situation.
authors.affiliation: Department of Orthopaedic Surgery, Washington University School of Medicine, Euclid Ave, St Louis, MO 63110, USA. rossj@wudosis.wustl.edu
authors.forename: James R
authors.initials: JR
authors.lastname: Ross
authors.forename: Matthew B
authors.initials: MB
authors.lastname: Dobbs
mesh_terms: D002648:Child; D005260:Female; D005500:Follow-Up Studies; D005532:Foot Deformities, Congenital / Q000000981:diagnostic imaging* / Q000601:surgery*; D006801:Humans; D007198:Indians, North American; D007592:Joint Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D010027:Osteotomy / Q000379:methods; D011859:Radiography; D016059:Range of Motion, Articular; D013640:Tarsal Joints / Q000000981:diagnostic imaging / Q000601:surgery*