Diagnostic Imaging for Tarso-Navicular Pain

Initial Diagnostic Approach

The American College of Radiology recommends conventional foot radiography as the initial imaging examination to evaluate tarso-navicular pain, with a sensitivity of 80-100% for detecting calcaneonavicular coalitions 1, 2
Standard foot radiographs (not ankle radiographs) allow for proper visualization of the tarso-navicular joint and identification of potential osseous causes of pain 1, 3
Lateral and oblique views of the foot are particularly useful for detecting calcaneonavicular coalitions, a common cause of pain in this region 1
Radiographs can also identify other causes of tarso-navicular pain, such as stress fractures, osteoarthritis, or painful accessory ossicles 2, 4

The American College of Radiology notes that radiographs may miss certain tarso-navicular pathologies, including talocalcaneal coalitions that can be obscured by overlapping structures 1
Stress fractures of the navicular bone often have limited sensitivity on standard radiographs, with a sensitivity of 12-56% 1
In cases of negative or equivocal radiographs but with a high clinical suspicion, advanced imaging examinations are recommended 5, 6
The American College of Radiology suggests that MRI of the foot without contrast is the examination of choice for evaluating soft tissue pathologies and occult stress fractures 5
CT scans are particularly useful for evaluating tarsal coalitions and occult fractures 7

Weight-bearing radiographs are recommended for optimal evaluation of foot structures 1, 4
For chronic midfoot pain of presumed osseous origin, MRI or CT scans are recommended after negative or equivocal radiographs 5
The American College of Radiology advises against relying solely on ankle radiographs for tarso-navicular pain, as this joint will not be properly visualized 1, 2

The American College of Radiology recommends not relying solely on standard radiographs in cases of high clinical suspicion of stress fracture or tarsal coalition not visible on radiographs 1, 2
The importance of oblique and lateral views of the foot should not be neglected for proper visualization of the tarso-navicular joint 1, 4