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Osteoarthritis of the talonavicular joint with pseudarthrosis of the navicular bone: a case report
© Kanzaki et al; licensee BioMed Central Ltd. 2011
Received: 8 August 2011
Accepted: 8 November 2011
Published: 8 November 2011
Osteoarthritis of the talonavicular joint caused by inflammatory, degenerative, and post-traumatic arthritis has been commonly described, and isolated arthrodesis for talonavicular joint has usually been performed for such conditions. However, arthritis accompanied by pseudarthrosis of the navicular bone is an extremely rare case, and to the best of our knowledge, isolated arthrodesis for this situation has not been previously described in any published reports.
The patient was a 39-year-old Japanese man. He had complained of pain in his left middle foot since a fall from his motorcycle six months previously. Radiographs and computed tomography (CT) scans revealed pseudarthrosis of the navicular bone. MRI indicated mild arthritic change in the talonavicular joint and avascular necrosis of the navicular bone. We performed an isolated arthrodesis of the talonavicular joint with two 6.5 mm cancellous screws. One year after the operation, radiographical bone union had been obtained, and the patient reported no pain and complete satisfaction with the result.
Isolated talonavicular arthrodesis is one of the effective procedures for the treatment of traumatic talonavicular arthritis with pseudarthrosis of the navicular bone both in providing pain relief and functional improvement.
Osteoarthritis of the talonavicular joint caused by inflammatory arthritis such as rheumatoid arthritis and pes valgus deformity has been commonly described [1, 2], but osteoarthritis occurring as a result of fracture of the navicular bone is rare . Arthritis accompanied by pseudarthrosis of the navicular bone is an extremely rare case.
Isolated arthrodesis for talonavicular joint has usually been performed for pes valgus deformities, congenital deformities, neuromuscular diseases, and arthritic conditions, including inflammatory, degenerative, or post-traumatic arthritis [3–11].
We report a case of osteoarthritis of the talonavicular joint accompanied by pseudarthrosis of the navicular bone, which was treated with isolated arthrodesis for the talonavicular joint.
A 39-year-old Japanese man sustained an injury to his left foot. He had fallen from his motorcycle and was unable to remember the precise mechanism of injury. He visited his local hospital where he was diagnosed with a navicular fracture and treated with a short-leg cast for six weeks. He was referred to our institution because of nonresolution of his prolonged foot pain six months after the initial injury.
There are few cases in the literature describing the result of isolated talonavicular arthrodesis in patients with traumatic arthritis [3, 6]. Most of the literature addresses patients with either inflammatory arthritis or adult acquired flat foot [4, 5, 7–11]. Main reported that the fracture of navicular was caused by shearing forces between the cuneiforms and the talar head, and triple arthrodesis was effective for persistent symptoms  while Chen maintained that isolated talonavicular arthrodesis provided both pain relief and functional improvement in traumatic arthritis .
In our case, images revealed aspects of osteoarthritis of the talonavicular joint and pseudarthrosis of the navicular bone, and we suspected lidocaine penetrated to the talonavicular joint and the gap of pseudarthrosis. Therefore, we thought the middle foot pain was caused by both osteoarthritis and pseudarthrosis and we planned to perform both a fixation of the navicular bone fragments and arthrodesis of the talonavicular joint. In fact, the gap of navicular pseudarthrosis was filled with soft fibrous tissues. However, no abnormal mobility between navicular bone fragments was identified. In the talonavicular joint, the articular surface was partially eburnated, and osteophyte and bone cyst were found. We concluded that the middle foot pain was derived from osteoarthritis of the talonavicular joint, and performed isolated arthrodesis for the talonavicular joint. However, if abnormal mobility had existed between the two fragments of the navicular bone, we would have performed not only arthrodesis of the talonavicular joint but also fixation of the navicular bone fragments or additional bone transplantation. As a result, three months after the operation, the patient felt no middle foot pain and was able to return to work as a bus driver. One year after the operation, radiography showed that the talonavicular joint was fully fused.
Isolated talonavicular arthrodesis is one of the effective procedures for the treatment of traumatic talonavicular arthritis due to an ununited navicular bone without abnormal movement both in providing pain relief and functional improvement.
Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of the journal.
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