Resectional arthroplasty: treatment for calcaneonavicular coalition

In a 10-year retrospective review of one practitioner's experience with calcaneonavicular tarsal coalitions, a diagnostic procedure based on clinical and radiographic examination is described. What typically may present as heel pain, on thorough clinical examination, may be identified more specifically as midtarsal pain. Radiographically degenerative changes may be identified through computed tomography as well as magnetic resonance imaging, bone scan, and plain radiographs. Treatment modalities are based on the degree of symptomatic degenerative changes present. In early stages, steroid injection is used to diminish inflammation at the midtarsal joint. Typically, this is performed with orthotic therapy to limit the motion at the calcaneonavicular coalition. More advanced stages will require surgical intervention. Based on the degree of degeneration at the more proximal subtalar joint, arthroplasty of the calcaneonavicular coalition without interposition of the extensor digitorum brevis has produced acceptable long-term results. If the subtalar joint has advanced degeneration and there has been failure of more conservative treatments, rearfoot arthrodesis has been performed.