An unusual cause of ankle pain: fracture of a talocalcaneal coalition as a differential diagnosis in an acute ankle sprain: a case report and literature review
This case reports an adolescent athlete with activity related chronic bilateral dorsal foot pain and stiffness. A 15 year old competitive female basketball player presented to a chiropractor subsequent to an unsuccessful course of conservative treatment for posterior tibial dysfunction. The patient's plain films were incorrectly read as normal and a CT scan obtained by the radiologist called the findings bilateral osteoarthritis. The patient was awaiting a referral to a rheumatologist at the time of initial consultation with the chiropractor. Examination revealed limited subtalar mobility and review of the images revealed bilateral non-osseous talocalcaneal coalition. The patient was subsequently directed to a pediatric orthopedic surgeon and is scheduled for a resection of the coalition. Primary care practitioners should be aware of this uncommon, but not rare, variable clinical presentation as misdiagnosis and mismanagement could lead to suboptimal patient outcomes. To our knowledge this is the first case report of a patient with tarsal coalition published in chiropractic literature. In addition, this case is the first to report radiographic evidence of chronic mechanical stress to the second metatarsal associated with tarsal coalition.