[Coalition 42] Naviculo-Cuboid (Cubonavicular) Coalition – The Rare One

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A naviculo-cuboid coalition is an uncommon congenital union between the navicular and cuboid bones. It accounts for <1% of all tarsal coalitions and may be isolated or coexist with other coalitions in the same foot.

Key Points for Radiologists

• Clinical: Often asymptomatic until adolescence. Symptomatic cases present with chronic midfoot pain, stiffness, restricted motion, and sometimes pes planus.
  
  
• X-ray: Findings subtle → narrow joint space, irregular margins. Important clue: no talar beak (since talonavicular mechanics remain unaffected).
  
  
• MRI:
  • Fibrous: low-signal band connecting bones.
  • Cartilaginous: intermediate/high signal bridge.
  • Reactive signs: marrow edema, subchondral cysts, bony hypertrophy.
  • Can also show stress fractures from altered biomechanics.
  
  
• Pitfall: Thickened naviculocuboid ligament can mimic coalition. Differentiate by absence of bone deformity or marrow edema.
  
  

Management

• Conservative first: NSAIDs, orthotics, PT, casting.
  
  
• Surgical: Coalition resection ± adipose graft if pain persists.
  
  

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