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A naviculo–medial cuneiform (NC) coalition is a rare congenital union of the navicular and medial cuneiform, usually fibrocartilaginous or cartilaginous. Unlike calcaneonavicular or talocalcaneal types (~90% of cases), this midfoot coalition is less familiar but may be more common than expected.
Key Points for Radiologists
- Prevalence: Reported in ~16% of foot coalitions in one study; more frequent in certain populations.
- Clinical: Often asymptomatic; when symptomatic → plantar midfoot pain worsened by activity. Not linked to peroneal spastic flatfoot.
- Imaging Findings:
• Location – plantar NC joint.
• Plain films/CT – irregular articular surface (97%), subchondral sclerosis (86%), cysts (83%), joint space narrowing (69%), beak-like medial spur (66%).
• MRI – low T1 / high T2 signal bridging at plantar margin; marrow edema may be present. - Differential: Can mimic OA, but coalition typically involves the plantar margin, whereas OA changes are more dorsal with large spurs.
Management
- Conservative: NSAIDs, arch supports – effective in most symptomatic patients.
- Surgery: NC fusion if pain persists; often combined with flatfoot reconstruction when talocalcaneal coalition coexists.
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