Tarsal Coalition of the Cuneiforms in an Elite Athlete: A Case Report

Abstract

Category: Midfoot/Forefoot, Sports Introduction/Purpose: Tarsal coalitions are a relatively common, often asymptomatic disorder with an incidence of 1-6% in clinical studies and 11-13% in cadaver studies. Calcaneonavicular, followed by talonavicular, are the most common forms of coalitions, but a variety of other coalitions have been described in radiographic, anatomic, and clinical literature. Despite the varied research that has focused on the topic in recent decades, there are no identified reports of cuneiform to cuneiform coalition in the literature. Methods: The authors present the unique case of medial and intermediate cuneiform coalition in a young female track athlete. A 19 year old female Division 1 hurdler presented with 1 year of atraumatic midfoot pain limiting her ability to compete. Despite evaluation by multiple orthopedic surgeons, the etiology of the pain was undetermined, and she had failed multiple conservative treatment options. Her exam revealed diffuse midfoot tenderness and increased midfoot pain with twisting motion. MRI and CT evaluation showed coalition between medial and intermediate cuneiforms with early degenerative changes. Ultrasound guided injection in this area resulted in relief of symptoms, confirming the diagnosis. The patient underwent coalition release and medial- intermediate cuneiform arthrodesis. Results: Postoperatively the patient underwent a period of nonweightbearing then progressed back to activity. CT scan confirmed solid arthrodesis and she was cleared to return to track competition. She successfully returned to competitive collegiate hurdling 11 months after surgery while noting only occasional discomfort in the foot. Conclusion: With no previous reports identified in the literature, cuneiform to cuneiform coalitions are a rare clinical entity. It is likely that the patient in the current case experienced symptoms related to this pathology because of her high level athletic participation. After failing conservative management, the patient experienced a good outcome after coalition release and arthrodesis. Although it is likely that patients with similar pathology who fail conservative management may expect similarly positive outcomes, review of future cases will help further define the optimal treatment for this condition.