TLAP = "too long" anterior process of calcaneus

NewsBot · Aug 15, 2006

Members do not see these Ads. Sign Up.
Arthroscopic resection of the calcaneonavicular coalition or the "too long" anterior process of the calcaneus.
Lui TH.
Arthroscopy. 2006 Aug;22(8):903.e1-4.

Calcaneonavicular coalition and the "too long" anterior process (TLAP) of the calcaneus can manifest as lateral foot pain, peroneal spastic flatfoot, and repeated ankle sprain. Surgical resection of the bone bar is frequently required. We present here an arthroscopic approach that can be used to accurately assess pathoanatomy and resect the bone bar. A portal is established slightly dorsal to the angle of Gissane. This is the primary visualization portal. The working portal, which is identified under an image intensifier, is located at the space between the talonavicular and calcaneocuboid joints, directly over the TLAP or the calcaneonavicular coalition. With the 2.7-mm 30 degrees arthroscope placed at the primary visualization portal, soft tissue around the TLAP or the calcaneonavicular coalition is cleared up with the use of an arthroscopic shaver at the working portal. After the TLAP or the calcaneonavicular coalition is clearly visualized, it can be resected with an arthroscopic burr through the working portal. The bone bar is resected proximally until the medial side of the calcaneocuboid joint, the lateral side of the taloavicular joint, and the plantar-lateral aspect of the talar head are clearly seen. Inversion stress should then be applied to the foot to prevent further impingement of the anteromedial process of the calcaneus to the plantar-lateral part of the talar head.
Click to expand...

Admin2 · Aug 15, 2006

Related thread:
STJ arthrofibrosis as a cause of ankle pain in children

NewsBot · Apr 29, 2009

A too-long anterior process of the calcaneus: a report of 31 operated cases.
El Hayek T, Dʼollone T, Rubio A, Lusakisimo S, Griffet J.
J Pediatr Orthop B. 2009 Apr 24. [Epub ahead of print]

A too-long anterior process of the calcaneus is one of the causes of repeated sprained ankles or painful feet in the child or adolescent that is often ignored and misdiagnosed. Among 31 cases of adolescents having consulted for these symptoms, a too-long anterior process of the calcaneus was discovered on radiographs, and explored in detail with a computed tomography scan or an MRI. The decision for surgical resection was taken considering the discomfort expressed by these children. The intraoperative observation corroborated the radiological findings and permitted a better understanding of the mechanisms responsible for the pain, the repeated sprained ankles and other instabilities. The surgical resection, which is a simple procedure, gave very good results. One must nevertheless be aware of the possible secondary lesions because of repeated sprained ankles: breakage of the lateral ligaments of the ankle and external malleolus nonunion or talus osteochondritis, which can compromise the operation's result, if they are not treated simultaneously.
Click to expand...

NewsBot · May 2, 2016

Too-long calcaneal process: Results of surgical treatment and prognostic factors.
Rosello O1 et al
Orthop Traumatol Surg Res. 2016 Apr 27

INTRODUCTION:
The too-long anterior process (TLAP) can be responsible for ankle pain or repeated sprains in children or adolescents. The objective of this study was to assess the results of TLAP surgical treatment and to analyze influencing factors in case of this surgery's failure.
MATERIAL AND METHODS:
Retrospective single-center study conducted from 2009 to 2012 including all patients under 18 years of age for a TLAP with follow-up equal to or longer than 1 year. The results of surgical treatment were assessed using the AOFAS score. Failure was defined as no significant improvement in the AOFAS score at the last follow-up.
HYPOTHESIS:
Predictive factors of the result of surgical treatment for TLAP can be identified.
RESULTS:
At the mean follow-up of 2.5 years, 35 patients (43 feet) fulfilled the inclusion criteria. Thirteen feet (30%) presented surgical failure. According to the AOFAS score, the results were excellent in 30 feet (70%), good in four (9%), fair in five (12%), and poor in four (9%). Surgical failure was influenced by the patient's age at the onset of symptoms and at the time of surgery, the degree of functional limitation, the duration of symptoms before surgery, the number of sprains, and gender (P<0.05).
CONCLUSION:
Firstly, in this pediatric population with its high functional demand, the overall rate of failure of TLAP surgery was 30%. Secondly, the factors associated with failure demonstrated made it possible to identify the ideal patient for this surgery: male, with symptom onset between 7 and 10 years of age, who had experienced fewer than 15 sprains, and undergone surgery in the 3 years following the beginning of symptoms.
Click to expand...

NewsBot · Oct 22, 2016

Arthroscopic Resection of Too-Long Anterior Process of the Calcaneus
Tun Hing Lui
Arthroscopic Techniques; Article in Press

A too-long anterior process (TLAP) of the calcaneus is an elongated anteromedial process of the calcaneus impinging the navicular or the talar head. TLAP can cause recurrent ankle sprain, peroneal muscle spasm, or persistent tarsal pain in adolescents. Arthroscopic resection is indicated if the symptoms do not respond to conservative treatment. It has the advantage of assessment of completeness of bone resection and treatment of associated lesions of the adjacent joints. The purpose of this technical note is to report an arthroscopic approach of the resection of the TLAP with the lateral midtarsal portal as the viewing portal.
Click to expand...

NewsBot · Jan 11, 2018

Does arthroscopic resection of a too-long anterior process improve static disorders of the foot in children and adolescents?
Bourlez J et al
Int Orthop. 2018 Jan 8. doi: 10.1007/s00264-017-3740-7.

PURPOSE:
A too-long anterior process of the calcaneus is a common cause of pain and hind-foot instability. Our goal was to evaluate the early results of arthroscopic resection in terms of static foot disorders in children and adolescents.

METHODS:
We retrospectively studied 11 ft (10 patients). The inclusion criteria were treatment of TLAP by arthroscopic resection and a minimum follow-up period of six months. Surgery was indicated in cases with persistent symptomatic TLAP resistant to orthopaedic treatment.

RESULTS:
The mean age at surgery was 11 (range, 7-15) years. The mean follow-up duration was 15 (range, 8-28) months. Pre-operatively, we diagnosed four flat feet, two cavus feet and five feet with normal footprints, but loss of physiological hind-foot valgus. All patients presented with subtalar joint stiffness. At the last follow-up, four feet with no hind-foot valgus were normal, two were unchanged and the other feet had improved. The mean AOFAS increased from 61.9 (range, 47-73) to 89.1 (range, 71-97; P = 0.009). The mean radiological angles were near normal, exhibiting significant improvements in the lateral talo-metatarsal and Djian-Annonier angles.

CONCLUSIONS:
Arthroscopic resection of a TLAP is safe. In the short term, the restoration of subtalar mobility reduces pain, and improves instability and static disorders. Longer follow-up of a larger patient series is required.
Click to expand...

NewsBot · Jan 17, 2021

Arthroscopic Calcaneonavicular Coalition and Too-long Anterior Process of the Calcaneus Resection in Children
Jorge Knörr, MD et al
Jfas:January 16, 2021

Persistent symptomatic calcaneonavicular coalition (CNC) and too-long anterior process of the calcaneus (TLAP) are congenital disorders that can benefit from surgical treatment. The arthroscopic technique for CNC and TLAP resection has previously been described. The aim of this prospective study was to describe outcomes following arthroscopic resection of 12 (38.71%) CNC and 19 (61.29%) TLAP cases in 30 consecutive pediatric patients treated between July 2009 and March 2013. There mean age was 12.4 (range 10 to 15) years, and the mean follow-up was 55.2 (range 24 to 79) months. Radiographs, American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scores, AOFAS pain scores, and patient satisfaction were assessed. All final postoperative imaging scans revealed complete synostosis resection without recurrence. The mean overall AOFAS Ankle-Hindfoot Score increased from 78.87 (95% confidence interval [CI] 76.74 to 81.01) to 93.06 (95% CI 91.10 to 95.03) ( p < .001). All patients showed pain reduction after surgery; even 1 patient (3.23%) who initially developed complex regional pain syndrome eventually had a successful outcome. The mean AOFAS pain score increased from 23.87 (95% CI 22.05 to 25.69) to 34.84 (95% CI 32.97 to 36.70) ( p < .001). All patients were either satisfied (n = 9 [30%]) or very satisfied (n = 21 [70%]) with the intervention at the final follow-up. Although both arthroscopic CNC and TLAP resection are demanding techniques, they allow for precise coalition resection through a less invasive approach, which may ultimately lead to faster recovery and improved outcomes.
Click to expand...

NewsBot · May 21, 2021

This clinical trial was just registered:
Evaluation of Clinical Features and Surgical Outcomes of the Too Long Anterior Process in Children

Calcaneonavicular coalition represents approximately 1% of the population between 8 and 12 years. They are manifested by repeated ankle sprains or by pain. - The diagnosis is radiological on an X-ray of the foot in oblique-3/4 incidence as well as magnetic resonance imaging. Treatment is second-line surgery after failure of orthopedic treatment. This surgery is either by direct approach or by arthroscopy, by performing a bone resection to recreate sufficient space in the joint in question. The patients in this study will only be operated on openly.
Click to expand...

NewsBot · Oct 17, 2021

Arthroscopic Resection of Too-Long Anterior Process of the Calcaneus
Tun Hing Lui et al
October 17, 2016

A too-long anterior process (TLAP) of the calcaneus is an elongated anteromedial process of the calcaneus impinging the navicular or the talar head. TLAP can cause recurrent ankle sprain, peroneal muscle spasm, or persistent tarsal pain in adolescents. Arthroscopic resection is indicated if the symptoms do not respond to conservative treatment. It has the advantage of assessment of completeness of bone resection and treatment of associated lesions of the adjacent joints. The purpose of this technical note is to report an arthroscopic approach of the resection of the TLAP with the lateral midtarsal portal as the viewing portal.
Click to expand...

NewsBot · Mar 9, 2022

The too-long anterior process and osteochondral lesion of the talus: is there an anatomical predisposition? A case-control study on 135 feet
JulietteWartelle et al
Foot and Ankle Surgery 9 March 2022

Introduction
The too-long anterior process (TLAP) increases mechanical stress on the hindfoot and could lead to osteochondral lesions of the talus (OLT) by localized hyper-pressure. The purpose of this study is to investigate an association between TLAP and OLT in children.

Methods
This is a retrospective, multicenter, case-control study conducted between 2010 and 2020. The OLT group was compared to a control group (CoG). TLAP is characterized by a distance between the anteromedial process of the calcaneus and the navicular bone (CN) of <5 mm.

Results
Forty-three feets were included in the OLT group and 92 in the CoG. The OLT group had a lower CN distance on CT than the CoG, a median of 2.8 mm versus 3.75 mm (p=0.002); 86% of patients (37 feet/43) in the OLT group had a CN distance of <5 mm (OR=3.0 [1.1; 9.5], p=0.023) compared to 67% in the CoG.

Discussion
The OLT group had an increased risk of developing TLAP compared to the CoG.
Click to expand...

NewsBot · Nov 19, 2022

Interrelations Between the Too-Long Anterior Calcaneal Process, Hind and Mid-tarsal Bone Volumes, Angles and Osteochondral Lesion of the Dome of the Talus: Analysis by Software Slicer of 69 CT Scan of Feet
Giovanni Lucchesi, François Bonnel, Nicolas Mainard, Natalie Orlando, Riccardo Sacco, Alain Dimeglio, Nathalie Boutry & Federico Canavese
Indian Journal of Orthopaedics (2022)

Introduction
Although the association between Too-Long Anterior Calcaneal Process (TLACP) and osteochondral lesion of the dome of the talus (OCL) has been hypothesized, no study has investigated the interrelations between TLACP, hind and mid-tarsal volumes and angles and the development of OCL. The main goals of this work are: (1) to measure the volume of the calcaneum, talus, navicular and cuboid in subjects with and without TLACP; (2) to evaluate the angular relationships between talus, calcaneum and navicular in subjects with and without TLACP; (3) to assess whether TLACP has an effect on the volume of OCL.

Methods
This is a retrospective study of 69 CT scans of 54 consecutive children aged 11–15 years who had undergone a CT scan due to symptomatology suggestive of TLACP. The 3D Slicer software allowed to calculate the volume of the talus, calcaneum, navicular, cuboid, TLACP and OCL (in cm3). The PACS system was used to perform the angular measurements (in degrees) between talus, calcaneum and navicular in the frontal, axial and sagittal plane.

Results
Amid the 69 CT scans, 49 were found to have pathologies related to TLACP (71%, TLACP Group) and 20/69 were normal (29%, Control Group). The mean hind and mid-tarsal bone volumes of the TLACP group were comparable to those of the control group. There were 40 (81.6%) OCLs detected exclusively in pathological feet (TLACP group); 32 lesions were medial (80%), and 8 lesions were lateral (20%). According to Ferkel and Sgaglione CT Staging System, there were 22 (55%) stage 1 lesions, 5 (12.5%) stage 2A, 3 (7.5%) stage 2B and 10 (25%) stage three lesions. Only the angle between the talus and calcaneum in the frontal plane was significantly lower in pathological feet with respect to the control group (p < 0.001). In pathological feet, the talus was supinated, and the calcaneus pronated.

Conclusions
TLACP tend to stiffen the foot, modifying its biomechanics and leading to supination of the talus and pronation of the calcaneum. This induces an overpressure at the medial side of the talus where we observed a greater frequency of medial OCL with larger volume than lateral OCL.
Click to expand...

NewsBot · Apr 13, 2023

Evaluation of surgical outcomes of calcaneonavicular coalition and too-long anterior process in children: a prospective study
Timothé Lescot et al
Orthop Traumatol Surg Res. 2023 Apr 10

Introduction: Calcaneonavicular coalitions (CC) affect approximately 1% of the general population. CC or Too-long anterior process (TLAP) result in "repeated sprains" that can be associated with foot and/or ankle chronic pain. The main objective of this study was to analyze the effectiveness of surgery using the AOFAS score.

Hypothesis: functional results after surgical treatment of CC or TLAP are not as good as expected.

Materials and methods: A single-center prospective study was carried out at our University Hospital from 01/01/2019 to 06/01/2021. The patients included were operated on in the pediatric surgery department for CC or TLAP resection by direct approach after MRI confirmation and failure of non-operative treatment. A survey evaluating the AOFAS score as well as the number of ankle sprains and the intensity of pain was undertaken at the preoperative consultation and then at three and twelve months postoperatively.

Results: A total of 17 feet in 16 patients (14 girls and 2 boys) comprising 12 TLAP and 5 CC were included. The AOFAS score was statistically significantly increased (58.6 vs. 82.9; p < 0.001) postoperatively. No statistical difference was noted between the follow-up visits at three and twelve months. At the twelve-month follow-up, 9 out of 16 patients (56.2%) still reported activity restrictions, mainly linked to the persistence of chronic pain, and 10 out of 16 patients (62.5%) reported a feeling of instability.

Discussion: CC and TLAP surgery rapidly improves function but it does not dramatically reduce foot pain and activity restrictions. A dedicated score would be useful to identify patients who will benefit the most from surgery.
Click to expand...

NewsBot · Jan 19, 2024

Imaging characteristics of too-long anterior process syndrome in children and adolescents
Charlotte Chiri et al
Pediatr Radiol. 2024 Jan 19

Background: In the presence of pain over the lateral aspect of the foot or recurrent ankle sprain in children, medical imaging is often employed to investigate potential causes, such as a calcaneonavicular coalition or a too-long anterior process (TLAP) of the calcaneus. Diagnosis and categorization of calcaneonavicular coalitions (synostosis, synchondrosis, or synfibrosis) is generally facilitated through imaging, in contrast to TLAP, which lacks well-defined semiological characteristics, apart from a calcaneonavicular space measurement of less than 5 mm. However, this measurement initially performed on an oblique view radiograph can be subject to a lack of precision due to positional variations of the foot and overlapping bones. Furthermore, the differentiation between TLAP as an anatomical variant and TLAP syndrome (characterized by symptomatic presentation), remains a subject of uncertainty.

Objective: The objective of our retrospective study was to investigate the imaging diagnosis of TLAP syndrome.

Materials and methods: A retrospective unmatched case-control study was conducted, covering data from February 2014 to January 2021. All patients, included retrospectively and consecutively, were initially managed in our hospital with radiography and/or computed tomography (CT) and/or magnetic resonance imaging (MRI). Two radiologists independently reviewed the images taken (radiographs, CT scans, and MRIs) of patients undergoing treatment in pediatric orthopedics for TLAP syndrome and control subjects, utilizing a standardized questionnaire. The control group consisted of subjects with no features suggestive of TLAP syndrome. The questionnaire included measurements of the calcaneonavicular space and identification of indirect signs associated with calcaneonavicular coalitions, as described in the related literature.

Results: A total of 128 patients who met the inclusion criteria were included in the analysis, including 38 patients and 90 controls. The prevalence of TLAP was 71.5% in the study population and 62.6% among controls. A threshold measurement of the calcaneonavicular space at 3.2 mm favored TLAP syndrome (sensitivity=97%, specificity=70%, area under the curve [95% confidence interval] =0.881[0.812-0.949]), with better precision using CT. Three indirect signs were significant: the "anteater nose" sign, the talar beak, and the tapered anterior calcaneal process. These signs demonstrated an even stronger association with TLAP syndrome when observed in conjunction with a reduction in the calcaneonavicular space, particularly in CT scans.

Conclusion: TLAP is common among control subjects. Therefore, a variant appears to be the most plausible explanation and it can be considered a mild form of calcaneonavicular coalition. However, in conjunction with symptoms suggestive of TLAP syndrome, the diagnosis is further supported by imaging, specifically with a calcaneonavicular space measurement of less than 3.2 mm. This measurement is most accurately obtained using CT with 2-dimensional reconstructions in all three planes. The simultaneous presence of the "anteater nose" sign, the talar beak, or the tapered anterior calcaneal process provides additional diagnostic evidence. In the diagnostic approach of calcaneonavicular coalition, oblique foot radiography seems useful in initially detecting abnormal coalition (bony or not), and complementarily, CT emerges as the best modality to characterize TLAP syndrome.
Click to expand...

TLAP = "too long" anterior process of calcaneus

NewsBot The Admin that posts the news.

Admin2 Administrator Staff Member

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

The Running Injury Continuum tool

Decision-Making Tool for Prescribing Insoles

Sydney Podiatry Clinic for Sale - Motherhood and too much traffic

Is the too many toes sign something to be concerned with

PodEssential and Paeds-PodEssential triage tools to define “essential” podiatry services

ASICS launch tool to predict growth of the childs foot

Skellen tool

Share This Page

TLAP = "too long" anterior process of calcaneus

NewsBot The Admin that posts the news.

Admin2 Administrator Staff Member

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

The Running Injury Continuum tool

Decision-Making Tool for Prescribing Insoles

Sydney Podiatry Clinic for Sale - Motherhood and too much traffic

Is the too many toes sign something to be concerned with

PodEssential and Paeds-PodEssential triage tools to define “essential” podiatry services

ASICS launch tool to predict growth of the childs foot

Skellen tool

Share This Page

Useful Searches