Painful type II os naviculare: introduction of a standardized, reproducible classification system.

Authors

• Sarah I Kamel
• Jeffrey A Belair
• Tarek M Hegazi
• Ethan J Halpern
• Vishal Desai
• William B Morrison
• Adam C Zoga

Publication/Presentation Date

12-1-2020

Abstract

OBJECTIVE: To provide a novel MRI classification system for the symptomatic type II os naviculare by creating a standardized grading of associated bone marrow edema (BME) and correlating with patient symptoms.

METHODS: BME was classified on an ordinal scale: grade 1, faint signal immediately adjacent to the synchondrosis; grade 2, intermediate signal within the os and navicular tuberosity without extending to the navicular body; grade 3, intense signal extending to the navicular body. BME on 59 MRIs was independently graded by three radiologists. Inter- and intra-observer agreement was analyzed using intraclass correlation coefficient. Univariate and multivariate analyses assessed for patient and imaging characteristics predictive of subjective pain score. A cohort of 82 patients without BME represented a control group.

RESULTS: Inter-observer agreement of BME grade was 0.95 (CI 0.93-0.97) and intra-observer was 0.92 (CI 0.87-0.96), indicating excellent agreement. In patients with BME, predictors of more severe pain were longer duration of pain (p = 0.02) and presence of soft tissue edema overlying the os naviculare (p <  0.001). One hundred percent of subjects with BME localized their pain to the medial midfoot (59/59) versus 25.6% (21/82) of controls (p <  0.001).

CONCLUSIONS: This novel grading system provides reliable quantification of BME associated with os naviculare, which is a specific cause of medial foot/ankle pain. Early diagnosis is important as pain severity worsens with longer duration of symptoms. Pain severity is correlated with soft tissue edema overlying the os, which may be secondary to extrinsic compression, reactive to biomechanical stress, or reflect direct trauma.

Volume

49

Issue

12

First Page

1977

Last Page

1985

ISSN

1432-2161

Published In/Presented At

Kamel, S. I., Belair, J. A., Hegazi, T. M., Halpern, E. J., Desai, V., Morrison, W. B., & Zoga, A. C. (2020). Painful type II os naviculare: introduction of a standardized, reproducible classification system. Skeletal radiology, 49(12), 1977–1985. https://doi.org/10.1007/s00256-020-03503-y

Disciplines

Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods

PubMedID

32556471

Department(s)

Administration and Leadership

Document Type

Article