Calcaneo-navicular coalition

Case
This 13-year-old male player prevented with a history of recurring ankle sprains. At the time of his assessment his ankle ached at rest and his mother describes how he frequently walked with a limp. The most striking finding on his clinical examination was pronounced stiffness of his left sub-talar joint.

Findings
There is elongated of the anterior process of the calcaneus and the lateral plantar aspect of the navicular suggesting a fibrous or cartilaginous coalition between the calcaneus and navicular. This is further demonstrated on the MRI which shows an irregular osseous fragment and irregularity of the margins of the navicular and anterior process of the calcaneus. Bone oedema is present within the anterior process of the calcaneus and the small osseous fragment suggesting there has been a fracture of the anterior process.

Discussion
Given the pronounced stiffness and symptoms this young player was treated with surgical debridement of the coalition. Fat was interposed between the bones to limit the risk of recurrence. The other foot was checked and found to be normal (many coalitions are bilateral). The player was given an orthotic to support the medial arch. He was able to return to football at about five months following surgery.

Tarsal coalitions are caused by congenital fusion of the tarsal bones. It often remains undetected until the child starts to play sport at the age of nine or ten years. The two most common forms involve a bony or cartilaginous bar between the calcaneus and the navicular, or between the calcaneus and talus. In about 40% of cases it is bilateral.

Tarsal coalitions most commonly present with mid-foot pain after repetitive running and jumping. There is often also a history of recurrent ankle sprains. The key examination is a restriction of subtalar joint motion. There may be a rigid flat foot and localised tenderness in the region of the coalition. An x-ray series should be taken including a 45° oblique view. If these are normal and clinical suspicion persists CT or MRI should be ordered.

Treatment may need orthotic therapy, with surgical excision after failure of conservative therapy. The bar may recur after surgery when interposition of the tissues after bar excision are not used.

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Bangoura
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L entorse de la cheville chez un enfant de 13 ans doit être l objet d une prise en charge surtout si elle est recidivente
Elles se classent en 2 groupes
L entorse bénigne et L entorse Grave
La première prise en charge c est la RADIOGRAPHIE et si le doute s installe on passe à l IRM pour avoir un diagnostic pressés et si la chirurgie s impose alors on prend des dispositions car c est la méthode la plus sure