Anatomical and Clinical Significance of Intermetatarsal Coalition: Meta-Analysis
Abstract
Aim: This study aimed to evaluate the anatomical patterns, clinical presentations, and radiological features of intermetatarsal coalition, a rare foot anomaly in the literature, through a systematic synthesis. Materials and Methods: This study is a systematic review and meta-analysis conducted in accordance with the PRISMA guidelines. A comprehensive search was performed on PubMed, Scopus, and Google Scholar databases (1946–2025). Studies reporting confirmed cases of intermetatarsal coalition were included in the analysis. Patient demographics, anatomical location, histopathological type (oseous, fibrous, cartilaginous), clinical symptoms, diagnostic tools, and treatment outcomes were systematically recorded and analyzed using descriptive statistics. Results: A total of 17 cases reported in 15 articles were identified. The mean age of the patients was 28.1 ± 16.3 years. Analyses showed that intermetatarsal coalitions were predominantly clustered between the 4th and 5th metatarsals (70.6%, n=12), followed by cases between the 1st and 2nd metatarsals (23.5%). Most cases were unilateral (88.2%) and of the oseous type (94.1%). The most common clinical presentation was chronic dorsolateral or forefoot pain. While early cases were diagnosed only with conventional radiography, current literature emphasizes the necessity of CT and MRI in identifying fibrous coalitions and in surgical planning. Surgical resection has been shown to be the primary treatment method and has yielded successful results in all reported cases. Conclusion: Intermetatarsal coalition is a rare but often overlooked cause of non-specific metatarsalgia. High clinical suspicion and the use of advanced imaging techniques (CT/MRI) are essential for early diagnosis, especially in adolescents and young adults. Surgical resection remains the gold standard for restoring biomechanical function and preventing degenerative progression, significantly improving patient quality of life.
Keywords
Intermetatarsal coalition, foot pain, non-specific metatarsalgia, metatarsal synostosis, systematic review.
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