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coalition excision with fat interposition
15%
577/3846
coalition excision with extensor digitorum brevis interposition
7%
282/3846
subtalar arthrodesis
1%
20/3846
4 weeks of immobilization in a short leg cast
75%
2879/3846
excision of accessory navicular
2%
63/3846
Select Answer to see Preferred Response
The history and imaging are consistent with a symptomatic calcaneonavicular coalition. The short duration of pain with no known history of prior symptoms warrant a trial of non-operative treatment with immobilization. Symptomatic hindfoot coalition is a relatively rare condition, occurring in approximately 1% of the population. The two most common locations are the talocalcaneal (middle facet) and calcaneonavicular joints. Diagnosis should be suspected in the pre-teen or teenage patient with insidious or sudden onset of pain in the midfoot to hindfoot, and/or a frequent history of ankle sprains. Vincent reviews the management of tarsal coalitions and the painful flatfoot. The authors notes that the initial management of symptomatic coalitions should consist of a trial of immobilization with transition to an orthosis. Mosca in a more recent review also notes that surgery should be reserved for those who have failed a prolonged initial nonoperative course of treatment. Incorrect answers: Answers 1 and 2: Coalition resection, with or without interposition, would only be considered if the patient had recurrent symptoms after a trial of non-operative treatment Answer 3: Subtalar arthrodesis is rarely indicated in young patients with calcaneonavicular coalitions Answer 5: The exam and imaging are not consistent with an accessory navicular
4.3
(25)
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