Talocalcaneal coalition

NewsBot · Oct 16, 2009

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Results of resection for middle facet tarsal coalitions in adults.
Philbin TM, Homan B, Hill K, Berlet G.
Foot Ankle Spec. 2008 Dec;1(6):344-9.

The optimum surgical procedure for talocalcaneal coalitions has not been definitively determined. The authors performed this study to evaluate the results achieved with talocalcaneal tarsal coalition resection with regard to preoperative radiographic findings in relation to postoperative outcomes. They reviewed the medical records of 7 patients and conducted telephone interviews using a modified American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale. The average age at surgery was 31 years (range, 15-56 years), and the follow-up period averaged 17.4 months (range, 7-36 months). In 6 cases, the resection was successful, with the mean preoperative Ankle-Hindfoot score of 36.5 improving to 50.5 (P = .51). One patient failed the resection and underwent a subtalar arthrodesis 1 year after the resection procedure. Radiographic evaluation showed that higher cartilaginous content of the tarsal coalition was associated with a better outcome in Ankle-Hindfoot scores (r = .894, P = .016); the relationship of patient age and changes in scores was r = .692 but was not statistically significant because of small sample size. Resection of tarsal coalition led to higher Ankle-Hindfoot scores for 6 of 7 patients at least 1 year postoperatively, and that higher cartilagenous content of the coalition was statistically significantly correlated with better postoperative outcomes.
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NewsBot · Dec 8, 2009

A Critical Evaluation of Subtalar Joint Arthrosis Associated with Middle Facet Talocalcaneal Coalition in 21 Surgically Managed Patients: A Retrospective Computed Tomography Review. Investigations Involving Middle Facet Coalitions-Part III.
Kernbach KJ, Barkan H, Blitz NM.
Clin Podiatr Med Surg. 2010 Jan;27(1):135-43.

Symptomatic middle facet talocalcaneal coalition is frequently associated with rearfoot arthrosis that is often managed surgically with rearfoot fusion. However, no objective method for classifying the extent of subtalar joint arthrosis exists. No study has clearly identified the extent of posterior facet arthrosis present in a large cohort treated surgically for talocalcaneal coalition through preoperative computerized axial tomography. The authors conducted a retrospective review of 21 patients (35 feet) with coalition who were surgically treated over a 12-year period for coalition on at least 1 foot. Using a predefined original staging system, the extent of the arthrosis was categorized into normal or mild (Stage I), moderate (Stage II), and severe (Stage III) arthrosis. The association of stage and age is statistically significant. All of the feet with Stage III arthrosis had fibrous coalitions. No foot with osseous coalition had Stage III arthrosis. The distribution of arthrosis staging differs between fibrous and osseous coalitions. Only fibrous coalitions had the most advanced arthrosis (Stage III), whereas osseous coalitions did not. This suggests that osseous coalitions may have a protective effect in the prevention of severe degeneration of the subtalar joint. Concomitant subtalar joint arthrosis severity progresses with age; surgeons may want to consider earlier surgical intervention to prevent arthrosis progression in patients with symptomatic middle facet talocalcaneal coalition.
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NewsBot · Dec 17, 2009

Plantar contact stress and gait analysis after resection of tarsal coalition.
Skwara A, Zounta V, Tibesku CO, Fuchs-Winkelmann S, Rosenbaum D.
Acta Orthop Belg. 2009 Oct;75(5):654-60.

The purpose of this study was to assess the foot loading characteristics and foot function of patients after operative correction of a tarsal coalition. Ten patients who had undergone operative treatment of a tarsal coalition were included in this study. One foot was affected in five patients and both feet in the other five. A calcaneonavicular coalition was present in 12 feet and a talocalcaneal coalition in three feet. Mean follow-up was 11.3 years. Clinical evaluation was based on a standardized questionnaire, a visual analogue scale for pain (VAS), the American Orthopaedic Foot and Ankle Society (AOFAS) Score and radiographic evaluation of the last radiographs. An objective analysis of foot loading characteristics was carried out with instrumented gait analysis and pedobarography. The clinical results were overall fair for pain, range of motion and walking distance. The AOFAS also showed fair results (mean: 78.1) at follow-up. Gait analysis revealed alterations in kinematic and kinetic parameters for the operated foot. Pedobarographic analysis showed altered loadings for heel and forefoot. In this study, operative treatment of tarsal coalition achieved fair clinical and radiographic results and did not restore physiologic gait and foot loading.
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NewsBot · Dec 30, 2009

Preliminary report: resection and interposition of a deepithelialized skin flap graft in tarsal coalition in children.
Sperl M, Saraph V, Zwick EB, Kraus T, Spendel S, Linhart WE.
J Pediatr Orthop B. 2009 Dec 24

Six tarsal coalitions in children were managed surgically using a deepithelialized skin flap for interposition after resection of the bony, fibrous or cartilaginous coalition. The advantage of this technique is that due to positioning the skin flap, joint motion can be preserved. The clinical results using the Ankle Hindfoot Scale of the American Orthopedic Foot and Ankle Society were excellent in two and good in four cases. The radiographs at follow-up showed no recurrences of the resected coalitions. This study shows that the use of deepithelialized skin flap interposition is effective in providing pain relief for the patients in symptomatic coalitions.
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NewsBot · Jul 30, 2011

Arthroscopic resection of talocalcaneal coalitions.
Bonasia DE, Phisitkul P, Saltzman CL, Barg A, Amendola A.
Arthroscopy. 2011 Mar;27(3):430-5.

Excision of symptomatic talocalcaneal coalitions, after failure of an adequate conservative treatment, is a widely accepted surgical treatment when less than 50% of the subtalar joint is involved and in the absence of degenerative changes to the subtalar or surrounding tarsal joints. Favorable results have been reported in 80% to 100% of patients with open resection. The traditional medial incision to the subtalar joint provides excellent exposure of the middle facet but inadequate visualization of the posterior facet. Other common disadvantages of the traditional open technique include (1) risk of incisional neuroma formation, (2) risk of superficial wound infection and delayed wound healing, and (3) prolonged hospitalization for wound management and pain control. Prone ankle/subtalar arthroscopy has been reported to yield excellent results in the treatment of numerous hindfoot pathologies, with the advantage of reducing postoperative pain, hospital stay, infection rates, wound complications, and recovery time. A posterior arthroscopic technique for posterior-facet talocalcaneal coalition excision has been developed in an attempt to reduce the complications of the traditional open resection. Possible disadvantages of the arthroscopic procedure may include (1) longer learning curve, (2) increased surgical time, (3) possible tibial neurovascular bundle damage, and (4) difficulties in using interposition material.
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NewsBot · Aug 16, 2011

Tarsal coalition resection with pes planovalgus hindfoot reconstruction.
Lisella JM, Bellapianta JM, Manoli A 2nd.
J Surg Orthop Adv. 2011 Summer;20(2):102-5.

Tarsal coalitions often present in young adults as a painful pes planovalgus hindfoot deformity. Resection of moderate and even large coalitions has become accepted as an alternative to arthrodesis. A review of the literature, however, suggests that coalitions with severe preoperative planovalgus malposition treated with resection are associated with continued disability and deformity. The authors believe that malposition contributes to persistent pain and disability after simple coalition resection. The hypothesis is that resection of the coalition with simultaneous hindfoot reconstruction can improve clinical and radiographic outcomes. Seven consecutively treated patients (eight feet) were retrospectively reviewed from the senior author's practice. Clinical exam, American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot scores, and radiographic measurements were evaluated after talocalcaneal coalition resection with simultaneous hindfoot reconstruction. All patients were satisfied and would have the same procedure again. All patients were either active students or gainfully employed at last follow-up. Clinical and radiographic hindfoot alignment was corrected reliably. The average increase in medial longitudinal arch height was 8.7 mm. After 2 years the average AOFAS hindfoot score was 88. Most patients had only mildly progressive arthrosis. There were two postoperative complications that resolved (superficial wound breakdown and calf deep vein thrombosis). This hindfoot reconstruction with coalition resection increased motion, reliably corrected malalignment, and improved pain. The authors believe that coalition resection and concomitant hindfoot reconstruction is a better option than resection alone or hindfoot fusion in patients with talocalcaneal coalition and painful pes planovalgus hindfoot deformity. Triple arthrodesis should be reserved as a salvage procedure.
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NewsBot · Sep 29, 2011

Dorsomedial talocalcaneal coalition: a rare condition
Muhm M, Ruffing T, Winkler H.
Orthopade. 2011 Mar;40(3):253-8.

Talocalcaneal coalitions are rare but a posterior facet talocalcaneal coalition is even rarer. There are three different types: fibrous, cartilaginous and osseous coalitions. Besides conventional x-rays computed tomography is essential for assessment of the subtarsal joint. In the absence of concomitant coalitions and foot deformity resection of the coalition is advocated due to good clinical results when there is an adequate size of the talocalcaneal joint (>50%) and without osteoarthrosis. A case of a rare posterior facet talocalcaneal coalition is reported.
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NewsBot · Nov 19, 2011

C-sign and talocalcaneal coalition
Tomčovčík L.
Acta Chir Orthop Traumatol Cech. 2011;78(5):468-71.

Talocalcaneal coalition is an abnormal bridge between talus and calcaneus, causing pain and restriction of subtalar movement; its incidence is less than 1 %. The signs and symptoms usually become manifest in the second decade of life with ossification of the lesion. They involve flat foot, peroneal muscle spasm, tarsal tunnel syndrome, or valgus tilt of the heel. The sings need not be noticeable and may appear only as tiredness and vague pain in the hind foot after exercise or an easily twisted ankle. The authors describe the case of talocalcaneal coalition in a 20-year-old man, incidentally diagnosed at ankle fracture. The presence of C-sign led to CT examination and the exact diagnosis. Radiological demonstration of this abnormality may be difficult because plain X-ray images in both projections may show normal findings. Literature data report, in addition to C-sign, further secondary signs of talocalcaneal coalition present on lateral radiographs of the ankle joint. Although these signs do not directly point to talocalcaneal coalition, they reveal abnormal anatomy or movement of the joint and may initiate more thorough examination by CT or MRI and the establishment of an exact diagnosis. Therefore, to know the secondary signs and pay attention to them is very useful. Key words: talocalcaneal coalition, tarsal, subtalar joint, radiography.
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NewsBot · Mar 14, 2012

Treatment of talocalcaneal coalitions.
Gantsoudes GD, Roocroft JH, Mubarak SJ.
J Pediatr Orthop. 2012 Apr;32(3):301-7.

BACKGROUND:
The purpose of this study was to review outcomes of patients treated for symptomatic talocalcaneal coalition with resection and interposition of fat graft.

METHODS:
A retrospective review was performed on all patients who underwent surgical treatment for symptomatic talocalcaneal coalition over a 13-year period. Ninety-three feet were treated with excision and fat graft interposition by 6 surgeons. All patients underwent a chart review. Patient's outcome was assessed at the last follow-up using the American Orthopaedic Foot and Ankle Society Hindfoot scale. Postoperative computed tomography scans were available for 20 feet.

RESULTS:
Forty-nine feet had follow-up of at least 12 months and had a score obtained through the American Orthopaedic Foot and Ankle Society Hindfoot scale. At an average of 42.6 months of follow-up, the average score obtained was 90/100 (excellent). The postoperative computed tomography scans demonstrated 1 recurrence (3%), which was treated with repeat excision. An additional patient was reoperated for failure to excise the coalition completely. Eleven patients (34%) underwent a subsequent surgery to correct the alignment of the foot. To the best of our knowledge, none of the patients excluded because of short follow-up had repeat surgery or recurrence.

CONCLUSIONS:
A symptomatic talocalcaneal coalition can be treated with excision and fat graft interposition, and achieve good to excellent results in 85% of patients. Patients should be counseled that a subset may require further surgery to correct malalignment.
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Admin2 · Sep 22, 2016

Here is a 50 minute video on managing tarsal coalitions:

NewsBot · Jul 31, 2012

Treatment of talocalcaneal coalitions.
Gantsoudes GD, Roocroft JH, Mubarak SJ.
J Pediatr Orthop. 2012 Apr-May;32(3):301-7.

BACKGROUND:
The purpose of this study was to review outcomes of patients treated for symptomatic talocalcaneal coalition with resection and interposition of fat graft.

METHODS:
A retrospective review was performed on all patients who underwent surgical treatment for symptomatic talocalcaneal coalition over a 13-year period. Ninety-three feet were treated with excision and fat graft interposition by 6 surgeons. All patients underwent a chart review. Patient's outcome was assessed at the last follow-up using the American Orthopaedic Foot and Ankle Society Hindfoot scale. Postoperative computed tomography scans were available for 20 feet.

RESULTS:
Forty-nine feet had follow-up of at least 12 months and had a score obtained through the American Orthopaedic Foot and Ankle Society Hindfoot scale. At an average of 42.6 months of follow-up, the average score obtained was 90/100 (excellent). The postoperative computed tomography scans demonstrated 1 recurrence (3%), which was treated with repeat excision. An additional patient was reoperated for failure to excise the coalition completely. Eleven patients (34%) underwent a subsequent surgery to correct the alignment of the foot. To the best of our knowledge, none of the patients excluded because of short follow-up had repeat surgery or recurrence.

CONCLUSIONS:
A symptomatic talocalcaneal coalition can be treated with excision and fat graft interposition, and achieve good to excellent results in 85% of patients. Patients should be counseled that a subset may require further surgery to correct malalignment.
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NewsBot · Aug 15, 2012

Mid-term outcome of talocalcaneal coalition treated with interposition of a pedicle fatty flap after resection.
Imajima Y, Takao M, Miyamoto W, Imade S, Nishi H, Uchio Y.
Foot Ankle Int. 2012 Mar;33(3):226-30.

BACKGROUND:
We have previously reported a new technique to treat symptomatic talocalcaneal coalition. The purpose of the present study was to evaluate the mid-term outcome of the interposition of a pedicle fatty flap after the resection of a talocalcaneal coalition.

METHODS:
Six feet of 5 patients with persistently symptomatic talocalcaneal coalition were treated with this method. We investigated the clinical outcome using the visual analog scale (VAS) for hindfoot pain including around coalition and the American Orthopaedic Foot and Ankle Society (AOFAS) score pre- and postoperatively, and investigated whether or not recurrence was present using computed tomography (CT) at the final followup.

RESULTS:
The VAS score was significantly improved from 5.5 +/- 1.0 (mean +/- SD) to 9.7 +/- 0.5 points (p = 0.0006). The AOFAS hindfoot score was also improved significantly (from 73.3 +/- 26.7 points to 96.7 +/- 7.1 points). No recurrence was detected by CT at the final followup.

CONCLUSION:
The interposition of a pedicle fatty flap after resection has been a durable procedure for treating a symptomatic talocalcaneal coalition.
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pjbramley · Aug 24, 2012

Thank you NewsBot and Admin2 for these postings. I was wondering if I could get feedback from anyone who has had experience with paediatric coalition patients, post-op. I have a 12y/o female client with bilateral coalitions at the talus-calcaneus near the sustentaculum tali. There is synostosis with an incomplete fusion. She has been in considerable pain for at least 12 months and the pain is deteriorating to the point where walking for any more than 20 minutes results in considerable pain. Conservative management has been limited in its success. The young lady has seen an orthpod who told her that surgery had a 50% chance of success. As I have had limited experience with coalitions which require surgery, I was wondering what some of the complications may be. Needless to say, both the young lady and her parents are anxious about how to make the best decision. Thanking you all in advance.

NewsBot · Sep 6, 2012

Talocalcaneal Tarsal Coalitions and the Calcaneal Lengthening Osteotomy: The Role of Deformity Correction
Vincent S. Mosca; Wesley P. Bevan
J Bone Joint Surg Am, 2012 Sep 05;94(17):1584-1594

Background:
Surgical resection of persistently painful talocalcaneal tarsal coalitions may not reliably relieve symptoms in patients with large coalitions associated with excessive hindfoot valgus deformity and subtalar posterior facet narrowing. Since 1991, calcaneal lengthening osteotomy, with or without coalition resection, has been used at our institution to relieve symptoms and to preserve motion at the talonavicular and calcaneocuboid joints.

Methods:
We retrospectively reviewed the records for eight patients with thirteen painful talocalcaneal tarsal coalitions who had undergone a calcaneal lengthening osteotomy for deformity correction with or without coalition resection between 1991 and 2005. Preoperative and postoperative clinical, radiographic, and computed tomographic records were reviewed. The duration of clinical follow-up ranged from two to fifteen years.

Results:
Calcaneal lengthening osteotomy fully corrected the valgus deformity and provided short-to-intermediate term pain relief for the five patients (nine feet) in whom the talocalcaneal tarsal coalition was unresectable. The patient with resectable coalitions but excessive valgus deformities underwent calcaneal lengthening osteotomies along with coalition resections and had excellent deformity correction and pain relief in both feet. One of the two patients who underwent calcaneal lengthening osteotomy years after coalition resection had excellent correction and pain relief. The other patient had a coincident calcaneonavicular coalition and severe degenerative arthritis in the talonavicular joint. He underwent concurrent arthrodesis of the talonavicular joint and, although he had excellent deformity correction, had persistent pain. All feet underwent concurrent gastrocnemius or Achilles tendon lengthening.

Conclusions:
It is generally accepted that resection is the treatment of choice for an intractably painful small talocalcaneal tarsal coalition that is associated with a wide, healthy posterior facet and minimal valgus deformity of the hindfoot. Although triple arthrodesis has been recommended for those who do not meet all three criteria, the present study suggests that an algorithmic treatment approach is justified. Treatment of the valgus deformity appears to be as important as that of the coalition. Calcaneal lengthening osteotomy with gastrocnemius or Achilles tendon lengthening is effective for correcting deformity and relieving pain in rigid flatfeet, just as it is in flexible flatfeet.
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NewsBot · Feb 14, 2013

Diagnosis and treatment of tarsal coalitions and synostoses in children and adolescents.
Hamel J.
Orthopade. 2013 Feb 8.

The majority of tarsal coalitions are located in the calcaneonavicular and talocalcaneal regions and other locations are rare. Complete early ossified synostoses are found not only in major limb deficiencies but also in otherwise normal feet. Magnetic resonance imaging (MRI) and computed tomography (CT) scans are the most important imaging techniques especially for preoperative planning. Early resection is advisable in calcaneonavicular coalitions as soon as it is detected in childhood and adolescence. Indications for or against resection or limited tarsal fusion are much more difficult in talocalcaneal coalition. The patient's complaints, extension and location of the coalition, additional malalignment and especially patient age are some of the factors that should be considered carefully. Results of surgical resection are not always satisfactory with a long-lasting rehabilitation especially in older children or adolescents and the necessity for secondary procedures can never be ruled out. In cases of malalignment corrective tarsal osteotomy can be considered as a simultaneous or staged procedure. An overview with special emphasis on surgical options is presented with typical examples as well as rare conditions and a review of important literature from recent years is included.
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NewsBot · Feb 16, 2013

Surgical treatment of talocalcaneal coalition
Yu G, Li C, Li B, Yang Y, Li H, Zhou J, Yuan F.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2012 May;26(5):522-6.

OBJECTIVE:
To explore the operative method and effectiveness of talocalcaneal coalition.

METHODS:
Between July 2008 and October 2010, 10 patients with talocalcaneal coalition were treated, including 2 cases of congenital talocalcaneal coalition and 8 cases of secondary talocalcaneal coalition. There were 4 males and 6 females, aged 53.5 years on average (range, 16-70 years). Three patients had middle-facet talocalcaneal coalition and 7 had posterior-facet talocalcaneal coalition. The preoperative visual analogue score (VAS) was 9.0 +/- 0.4. According to American Orthopedic Foot and Ankle Society (AOFAS) hindfoot scale, the score was 42.4 +/- 1.4. Two cases complicated by subtalar degeneration. Resection of the bone bar and fat packing were performed in 8 cases of simple talocalcaneal coalition, and resection and subtalar arthrodesis in 2 cases of talocalcaneal coalition combined with subtalar degeneration.

RESULTS:
Primary healing of incisions was obtained in all patients. Eight patients were followed up 18 months on average (range, 12-36 months). At last follow-up, VAS was 2.0 +/- 0.7, showing siginificant difference when compared with preoperative score (t = 6.425, P = 0.000). AOFAS score was 86.9 +/- 2.3, showing significant difference when compared with preoperative score (t = 7.634, P = 0.000). The X-ray films showed that no recurrence of talocalcaneal coalition was observed in patients underdoing simple removal of bone bar, and bone fusion was observed in patients undergoing arthrodesis.

CONCLUSION:
To achieve satisfactory outcomes for talocalcaneal coalition, a reasonable surgical procedure should be chosen according to the specific facet and complication.
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NewsBot · Feb 23, 2013

Fibrin glue as interposition graft for tarsal coalition.
Weatherall JM, Price AE.
Am J Orthop (Belle Mead NJ). 2013 Jan;42(1):26-9.

We describe a surgical technique and report outcomes for fibrin glue interposition after resection of a tarsal condition. An institutional review board--approved retrospective review of all pediatric patients with a tarsal coalition managed with resection was conducted between January 2002 and July 2010 by a single surgeon. All coalitions were resected with interposition of fibrin glue. Patients were evaluated for postoperative complications, pain, weight-bearing status, return to sports, and ankle and subtalar range of motion. Six feet without a coalition were used as a control group. Nine patients (12 feet) were identified with mean follow-up of 2.1 years (range, 7-72 months). Pre-operative complaints were predominantly foot and ankle pain. Patients also reported flatfeet and recurrent ankle sprains. There were no reported postoperative complications. All 9 patients were weight-bearing as tolerated and returned to sports by 6 months. Fibrin glue is a safe and reliable alternative to tissue grafts for interposition after resection of a tarsal coalition.
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NewsBot · May 9, 2013

Ultrasound of talocalcaneal coalition: retrospective study of 11 patients
Stefano Bianchi, Douglas Hoffman
Skeletal Radiology; May 2013

Objective
To present the ultrasound appearance of talocalcaneal coalitions (TCC).

Materials and methods
We present a retrospective review of 11 patients (8 women and 3 men, age range 17–58 years, mean age 35.3 years) in which ultrasound, the first imaging study carried out, detected a TCC that was not known or suspected clinically. Patients were subsequently examined by standard radiographs, computed tomography (CT) or magnetic resonance imaging (MRI).

Results
In 9 patients with fibrous coalition ultrasound showed a reduced joint space of the medial aspect of the anterior talocalcaneal joint associated with an irregular, pointed appearance of its outline. In 2 patients with osseous coalitions ultrasound revealed a smooth continuity of the hyperechoic bone surface between the medial talus and the substentaculum tali. The diagnosis was confirmed in 4 patients with CT and in 3 with MRI. In the remaining 4 patients standard radiographs were consistent with TCC.

Conclusion
Owing to its tomographic capabilities ultrasound can detect TCC. We suggest that study of the anterior subtalar joint should be a part of every ankle ultrasound examination as it can show a clinically unsuspected TCC. Confirmation of the coalition by CT or MRI is required in the preoperative assessment to better assess the type and extent of the congenital anomaly as well as the adjacent joints.
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NewsBot · May 15, 2013

Long-Term Functional Outcomes of Resected Tarsal Coalitions.
Khoshbin A, Law PW, Caspi L, Wright JG.
Foot Ankle Int. 2013 May 12.

BACKGROUND:
There are few long-term studies evaluating tarsal coalition resections. The purpose of this study was to compare patient outcomes following resection of calcaneonavicular (CN) and talocalcaneal (TC) bars and to determine the relationship between the extent of a coalition and the outcome of resection.

METHODS:
Patients younger than 18 years receiving resection for symptomatic tarsal coalition (1991-2004 inclusive) were eligible to participate. Follow-up evaluation included clinical examination to assess range of motion and self-reported functional outcome questionnaires. Two validated functional scales were used: the American Academy of Orthopaedic Surgeons (AAOS) Foot and Ankle Module, and the Foot Function Index (FFI). Twenty-four patients with 32 tarsal coalition resections (19 CN and 13 TC feet) were included in this study. For CN and TC patients, the mean age at the time of surgery was 11.8 ± 1.1 and 11.9 ± 2.5 years, and the mean age at follow-up was 27.1 ± 1.1 and 25.0 ± 2.5 years, respectively.

RESULTS:
Inversion and eversion were significantly less for TC feet when compared with CN (P = .03 and P = .01, respectively). No difference was noted between the CN and TC groups with respect to outcome scores. Furthermore, no association was noted between the size of TC coalition or hindfoot valgus angle with respect to outcome scores.

CONCLUSION:
Resected CN and TC bars behaved similarly in the long term in terms of function and patient satisfaction. Favorable results were attained when resections were performed on TC coalitions that were greater than 50% of the posterior facet and hindfoot valgus angles greater than 16 degrees.
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NewsBot · Jun 6, 2013

MIDDLE FACET TALOCALCANEAL COALITIONS WITH CONCOMITANT SEVERE FLAT FEET IN CHILDREN: “TO RESECT, RECONSTRUCT OR BOTH?”
O. Akilapa, C. Petrides and H. Prem
Bone Joint J 2013 vol. 95-B no. SUPP 24 18

Aim Historically, surgeons have focused on isolated simple coalition resection in symptomatic tarsal coalition with concomitant rigid flat foot. However, recent evidence suggests that coalitions with severe preoperative planovalgus malposition treated with resection alone are associated with continued disability and deformity. We believe that concomitant severe flatfoot should be considered as much as a pathological component and pain generator as the coalition itself. Our primary hypothesis is that simple resection of middle facet tarsal coalitions and simultaneous flat foot reconstruction can improve clinical outcomes.

Method We identified eleven children (13 feet) who had resections of middle facet tarsal coalitions with or without complex foot reconstruction (calcaneal lengthening, medial cuneiform osteotomy) for concurrent severe planovalgus between 2003 and 2011. Clinical examination, American Orthopaedic Foot and Ankle Society (AOFAS) hind-foot scores, and radiographic assessments were evaluated after resection of middle facet tarsal coalitions with simultaneous flat foot reconstruction.

Results Isolated coalition resection provided short to intermediate term pain relief for three children that had this as a solitary procedure. Calcaneal lengthening osteotomy performed as an additional procedure in patients with very severe and stiff planovalgus provided excellent correction and symptomatic pain relief in all six patients (Mean AOFAS: 91). Two patients had insertion of sinus tarsi implants in addition to resection also had satisfactory hind foot function (Mean AOFAS: 87.3) post operatively.

Conclusion This study shows that calcaneal lengthening osteotomy in addition to coalition resection in patients with severe rigid flat feet provides excellent pain relief and function. Rigid flat feet should be considered as a significant contributor to the pain complex in this cohort of patients.
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NewsBot · Jul 25, 2013

A radiological classification system for talocalcaneal coalition based on a multi-planar imaging study using CT and MRI.
Lim S, Lee HK, Bae S, Rim NJ, Cho J.
Insights Imaging. 2013 Jul 24.

OBJECTIVE:
To develop a radiological classification system for talocalcaneal coalition suitable for adults.
METHODS AND MATERIALS:
A retrospective review was performed on patients diagnosed with talocalcaneal coalition from July 2001 to November 2011. Based on the cartilaginous or bony nature, facet joint orientation and bony structure morphology, we classified talocalcaneal coalitions into four types: I (linear with or without posterior hooking), II (talar overgrowth), III (calcaneal overgrowth) and IV (complete osseous).
RESULTS:
Seventy feet (59 patients) with talocalcaneal coalition were evaluated by CT (61/70 feet) using multi-planar reformation and/or magnetic resonance imaging (43/70 feet). Type I, II, III and IV coalitions were detected in 45 (64 %), 10 (14 %), 13 (19 %), and 2 feet (3 %), respectively. Fracture fragments were observed in 16 feet (seven Type I and nine Type III coalitions) with hooked or overgrown calcanei and in one foot in the talus (Type I). Eleven patients had bilateral talocalcaneal coalitions; ten patients had coalitions of the same type and one had both Type I and Type III coalitions. Among 48 patients with unilateral involvement, the left and right feet were affected in 26 and 22 patients, respectively.
CONCLUSIONS:
A classification system for talocalcaneal coalition based on multi-planar imaging studies was developed.
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KEY POINTS:
• A classification system for talocalcaneal coalition based on multi-planar imaging was developed. • The relative frequencies of different talocalcaneal coalition types were determined. • Fracture fragments were easily distinguished and frequently originated from the calcaneus. • Fracture fragments were mostly associated with Type I (linear) with posterior hooking and Type III (calcaneal overgrowth).
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NewsBot · Oct 16, 2013

Middle subtalar osseous coalition with associated fusion of the sinus tarsi: a previously undescribed type of tarsal coalition
David A. Lawrence, Michael F. Rolen, Hicham Moukaddam
Clinical Imaging; Available online 10 October 2013

Tarsal coalitions affect up to 13% of the population and may cause chronic ankle and hindfoot pain. Coalitions can be subdivided as osseous, cartilaginous, or fibrous types. The most common type of tarsal coalition involvesthe talocalcaneal joint, where it usually affects the middle subtalar joint. In this article, we describe a previously unpublished form of talocalcaneal coalition with osseous coalition at the level of the middle subtalar joint with associated fusion of the sinus tarsi.
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NewsBot · Dec 21, 2013

Endoscopic Resection of a Talocalcaneal Coalition Using a Posteromedial Approach
Koji Hayashi, Tsukasa Kumai, Yasuhito Tanaka
Arthroscopy Techniques; Available online 14 December 2013

Resection is a standard surgical procedure for a talocalcaneal coalition (TCC). A posterior approach is the representative technique for hindfoot endoscopy, and there is only 1 report of endoscopic resection of TCC using this approach. Disadvantages of the posterior approach for TCC are as follows: (1) the indication is limited to posterior-facet coalition, (2) the flexor hallucis longus can be an obstacle in approaching the coalition, (3) the acute insertion angle between the endoscope and instrument reduces operability, and (4) a position change and additional skin incision are essential for conversion to an open procedure. In contrast, a posteromedial approach for TCC with established portals at the entrance and exit of the flexor retinaculum is a useful technique because (1) the indication is allow to middle- and posterior-facet coalitions, (2) increased perfusion pressure allows the creation of sufficient working space, (3) operating the instrument only at the coalition site decreases the risk of tendon injury and neurovascular damage, (4) the obtuse insertion angle between the endoscope and instrument improves operability, and (5) a position change and additional skin incision are unnecessary for conversion to an open procedure.
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NewsBot · Jan 25, 2014

Cavus foot deformity and concomitant talocalcaneal coalition in an adult patient: a case report with literature review
Oguz Cebesoy, Kamil Cagri Kose
CaseRepClinPractRev 2007; 8:CR229-232

Background: Although its mechanism is not clear, tarsal coalition is shown to be associated with cavus foot in a few cases. Except one, all reported cases are children or adolescents. The first line of treatment is conservative (most patients benefit). In refractory cases, soft tissue procedures or very rarely osteotomies are used for treatment.There is no algorithm for treatment of cavus foot with tarsal coalition in an adult.
Case Report: We report a case of talocalcaneal coalition in a 29 years old male which is refractory to conservative treatment.
Conclusions: The management of cavus foot with tarsal coalition unresponsive to conservative treatment in an adult, remains as a challenging problem for the orthopedic surgeon. Futher study is needed to understand the mechanism of this entity and to treat it effectively.
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NewsBot · Sep 25, 2014

Coalition resection and medial displacement calcaneal osteotomy for treatment of symptomatic talocalcaneal coalition: functional and clinical outcome.
El Shazly O, Mokhtar M, Abdelatif N, Hegazy M, El Hilaly R, El Zohairy A, Tawfik E.
Int Orthop. 2014 Sep 25.

PURPOSE:
The purpose of this study was to evaluate the functional and clinical outcome of combined TCC resection and medial displacement calcaneal osteotomy for treatment of symptomatic talocalcaneal coalition.
METHOD:
This is a prospective case series study on 27 patients (30 feet) who had symptomatic rigid pes planovalgus due to talocalcaneal coalition. All patients were treated by coalition resection and medial displacement calcaneal osteotomy. Pre-operative clinical and radiological assessment was done. Pain was assessed by visual analogue scale (VAS) and the functional assessment was done by the American Foot and Ankle Society score (AOFAS) for the hind foot. Pre-operative and postoperative plantar pressure assessment was done for all patients barefoot using the mat scan (Tekscan, Inc., vs. 6.34, Boston, USA).
RESULTS:
The mean follow-up period was 27.44 months (±2.47, range 23-33). Heel valgus improved from 15.03 (±6.9) degrees pre-operative to 3.09 (±2.3) degrees postoperatively. There was a statistically significant improvement in the VAS from 8.48 (±0.70) pre-operative to 3.70 (±1.13) postoperative. The mean AOFAS score showed statistically significant improvement from 39.88 (±6.09) pre-operative to 84.37 (±7.06) postoperative. There was a statistically significant decrease in mid foot pressure during standing from 48.05 kPa pre-operative to 35.30 kPa postoperative, and during walking from 148.08 kPa pre-operative to 90.22 kPa postoperative.
CONCLUSION:
A combination of medial displacement calcaneal osteotomy with TCC resection showed statistically significant improvement in VAS and AOFAS scores, as well as decreasing the plantar pressure on the mid foot during standing and walking.
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NewsBot · Feb 21, 2015

Subtalar Joint Distraction Arthrodesis to Correct Calcaneal Valgus in Pediatric Patients with Tarsal Coalition: A Case Series
Jaclyn M. Schwartz, DPM, Carl A. Kihm, DPM, Craig A. Camasta, DPM, FACFAS
The Journal of Foot & Ankle Surgery; Article in Press

Subtalar joint middle facet coalitions commonly present in children who have a painful, rigid, pes planovalgus foot type. The middle facet coalition allows rearfoot forces to be distributed medially through the coalition, and this can result in arthritis or lateral tarsal wedging. The senior author has used a wedged bone graft distraction subtalar joint arthrodesis to correct calcaneal valgus and restore the talar height in these patients. The tight, press-fit nature of the tricortical iliac crest allograft provides stability and can negate the need for internal fixation. We retrospectively reviewed 9 pediatric subtalar joint distraction arthrodesis procedures performed on 8 patients during a 6-year period. All patients began weightbearing at 6 weeks after surgery. All patients had osseous union, and no complications developed that required a second surgery. The clinical outcomes, assessed at a mean of 25.5 (range, 6.3 to 75.8) months postoperatively, were satisfactory. The mean American Orthopaedic Foot and Ankle Society score was 90.1 (range, 79 to 94), on a 94-point scale. The wedged distraction arthrodesis technique has not been previously described for correction of pediatric patients with lateral tarsal wedging, but it is an effective option and yields successful outcomes.
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NewsBot · Mar 11, 2015

Bilateral Tarsal Coalition: A Rare Case Report
E Ganesan, Balaji Arumugam, M S Rathinavel
source; full text

Tarsal coalition describes complete or partial union between two or more bones in the midfoot and hindfoot. The most commonly
reported tarsal coalitions are calcaneonavicular and talocalcaneal and the remaining coalitions such as calcaneocuboid,
talonavicular, cubonavicular being the rare presentations. One such case of tarsal coalition was reported in a 10-year-old boy
who had presented with painful swelling of both feet on the medial aspect, anterior to the medial malleolus since 12 months
without any history of trauma. On physical examination, a well defined bony swelling was observed on the anterior aspect of
the medial malleolus on both feet with mild tenderness on palpation. No limitations to foot movements and absence of muscle
stiffness in both feet. X-ray, computerized tomography scan and magnetic resonance imaging revealed fusion of talus and
navicular bones suggesting a rare case of talonavicular coalition.
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NewsBot · Apr 30, 2015

The use of a portable CT scanner for the intraoperative assessment of talocalcaneal coalition resections.
Kemppainen J, Pennock AT, Roocroft JH, Bastrom TP, Mubarak SJ.
J Pediatr Orthop. 2014 Jul-Aug;34(5):559-64

BACKGROUND:
Intraoperative assessment of talocalcaneal (TC) coalition resection can be challenging, with no reliable plain radiographic view available for evaluation. Therefore, in March of 2011, we began using a CereTom portable CT scanner to assess TC coalition resections intraoperatively. This study evaluates the use of intraoperative CT during surgical resection of TC coalitions.
METHODS:
Patients who received CT scans before and after TC coalition resection, by a single surgeon, were included. Those treated without (control group, n=12 feet) and with (intraoperative CT group, n=14 feet) intraoperative CT scan were retrospectively compared. Two blinded pediatric orthopaedic surgeons assessed the quality of resection using a side-by-side comparison of preoperative and postoperative CT scans. Each resection was rated as "excellent," "fair," or "poor," and medical records were reviewed to evaluate clinical outcome.
RESULTS:
Substantial agreement was found between blinded reviewers (κ=0.71, 81% absolute agreement). Quality of resection was improved in the intraoperative CT group, with 57% of patients receiving an excellent rating compared with 25% in the control group. Patients in the intraoperative CT group were 4.0 times more likely to have a complete resection as compared with patients in the control group; however, this was not statistically significant (odds ratio, P>0.05; 95% confidence interval, 0.74-21.5). Intraoperative CT altered surgical decision making in 3 feet (21%) in the intraoperative CT group, leading to further resection and a subsequent excellent postoperative rating in 2 of these patients. There was 1 reoperation in the control group for continued pain and residual coalition identified on postoperative CT scan. In the intraoperative CT group there have been no reoperations for recurrent or residual qcoalition.
CONCLUSIONS:
This study illustrates that intraoperative CT can alter surgical decision making and may improve the ability to obtain a complete resection in TC coalition surgery. In these technically challenging cases, intraoperative scans give immediate imaging feedback to surgeons, allowing intervention if residual resection is identified. If intraoperative CT scan is available, it should be considered for surgical treatment of TC coalition resections.
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NewsBot · Jun 3, 2015

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C-sign and talocalcaneal coalition
Tomčovčík L.
Acta Chir Orthop Traumatol Cech. 2011;78(5):468-71.
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C sign: talocalcaneal coalition or flatfoot deformity?
Moraleda L, Gantsoudes GD, Mubarak SJ.
J Pediatr Orthop. 2014 Dec;34(8):814-9. doi: 10.1097/BPO.0000000000000188.

BACKGROUND:
C sign is used to alert the physician of the possible presence of talocalcaneal coalition (TCC), so that advanced imaging can be ordered. The purpose of this study was to know the prevalence of the C sign among patients with TCC and its relationship to the presence of a TCC or to hindfoot alignment.
METHODS:
Retrospective reviews of the presence of C sign in radiographs of 88 feet with TCC (proved by computed tomography scan or surgical findings) and 260 flexible flatfeet were conducted. C sign was classified as complete and interrupted (types A, B, and C). The interobserver variability of the C sign was studied. Seven radiographic parameters were measured to analyze the relationship of these measurements with the presence or absence of the C sign.
RESULTS:
C sign was present in 68 feet (77%) with TCC: 14.5% complete and 62.5% interrupted (26% type A, 19.5% type B, and 17% type C). C sign was present in 116 flatfeet (45%), all of them interrupted (0.4% type A, 5.5% type B, and 39% type C). The talo-first metatarsal angle, the talohorizontal angle, the calcaneal pitch, the calcaneo-fifth metatarsal angle, and the naviculocuboid overlap presented a more pathologic value when a C sign was present. The κ-value for the presence of a C sign was 0.663.
CONCLUSIONS:
The so-called true C sign (complete or interrupted type A) indicates the presence of a TCC and it is not related to flatfoot deformity. However, it is only present in 41% of the cases. The interrupted C sign is much more likely to be related to flatfoot deformity than to the presence of a TCC, specifically when a type C is found.
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NewsBot · Oct 21, 2015

MRI Findings of Talocalcaneal Coalition: Two Case Reports.
Umul A
Acta Inform Med. 2015 Aug;23(4):248-9

INTRODUCTION:
Tarsal coalition is abnormal fusion of two or more tarsal bones and is a common cause of foot pain. There are osseous, cartilaginous and fibrous subtypes. Calcaneonavicular and talocalcaneal coalitions are more frequent. Radiography is the primary diagnostic tool, however CT and MRI are precious examinations for differential diagnosis of osseous /non-osseous coalitions separations. Furthermore, cross-sectional imaging methods indicate the extension and secondary degenerative joint changes.
CASE REPORTS:
The detection of bone marrow of edema in the articulation area is valuable for diagnosis Hereby, we present two cases, 24 years old female and 35 years old male, with the diagnosis of talocalcaneal coaliation. We also discuss MRI and radiographic findings.
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NewsBot · Nov 21, 2015

A Different Type of Talocalcaneal Coalition With Os Sustentaculum: The Continued Necessity of Revision of Classification.
Yun SJ et al
AJR Am J Roentgenol. 2015 Dec;205(6):W612-W618.

OBJECTIVE:
The objective of our study was to retrospectively determine the prevalence and image findings of extraarticular talocalcaneal coalition with os sustentaculum, a type of talocalcaneal coalition that does not appear in current classification systems, in patients with an imaging diagnosis of foot coalition.
MATERIALS AND METHODS:
This study was performed using a database query of radiology reports of ankle and foot CT or MRI examinations performed from August 2001 to November 2013. Eighty-one patients were identified through a keyword search of the database for "talocalcaneal coalition," "tarsal coalition," "coalition," or "os sustentaculum." Imaging features of CT or MRI findings were evaluated. Chart review was used to identify demographic information.
RESULTS:
Extraarticular talocalcaneal coalition with os sustentaculum was diagnosed in 13 patients (nine men, four women), which represents a prevalence of 16.0% (13/81) in all foot coalitions and 24.1% (13/54) in all talocalcaneal coalitions. Four of 13 patients underwent surgical resection, and histology was obtained in three patients. Nine patients who had no history of trauma were symptomatic and all patients with bone marrow edema at the coalition sites on MRI (n = 5) were also symptomatic. Coexisting extraarticular talocalcaneal coalition with os sustentaculum and intraarticular talocalcaneal coalition were observed in 11 of 13 patients.
CONCLUSION:
The os sustentaculum is a component of extraarticular talocalcaneal coalitions and as such is usually related to the presence of symptoms. If a patient with an os sustentaculum has symptoms in the medial talocalcaneal joint area, an extraarticular talocalcaneal coalition related to the os sustentaculum should be considered.
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NewsBot · Jan 29, 2016

A Rare Combination of Ipsilateral Partial Talocalcaneal and Talonavicular Coalition.
Kembhavi RS, James B.
J Clin Diagn Res. 2015 Dec;9(12):RD07-RD08

Tarsal coalitions refer to fibrous, cartilaginous or osseous fusion between two tarsal bones. Commonly seen are talocalcaneal coalitions and calcaneonavicular coalitions. Talonavicular, calcaneocuboid and cubonavicular coalition are very uncommonly seen. Talocalcaneal and calcaneonavicular coalitions are generally symptomatic whereas talonavicular coalitions are asymptomatic. Special view radiography, CT and MRI will be helpful in diagnosing coalitions depending on nature of coalitions. In this case report, we present 24-year-old male patient with rare combination of talocalcaneal and talonavicular coalition on ipsilateral side. Patient also showed talar beak sign and arthritic changes at subtalar joint. Considering first time presentation to hospital and milder symptoms, we treated patient conservatively with short leg cast and foot orthoses. With course of treatment, symptoms were relieved significantly.
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NewsBot · Feb 22, 2016

Posteromedial Ankle Impingement Caused by Hypertrophy of Talocalcaneal Coalition: A Report of Five Cases and Introduction of a Novel Index System
Weidong Song, MD, PhD, Wenzhou Liu, MS, Binghao Chen, MS, Adytia Anand, MS, Xiangyu Cheng, MS, Tao Yang, BS
JFAS; Article in Press

Ankle impingement syndromes are common disorders that can be attributed to many factors. To the best of our knowledge, posteromedial ankle impingement syndromes caused by talocalcaneal coalition have never been previously reported. The present report describes 5 patients with posteromedial ankle pain and inversion limitation. The physical examination, radiographic, and magnetic resonance imaging findings suggested posteromedial ankle impingement syndrome and talocalcaneal coalition. The 5 patients underwent surgery after conservative treatment had failed. A novel index system, namely the angle and thickness of the medial talocalcaneal facet, was introduced. The talocalcaneal coalitions protruded medially and impinged on the malleolus medialis. The medial facet of the talus and calcaneum had a wider angle and thickness than normal. Pain relief was noted, and good long-term outcomes were achieved after resection of the medial prominence and coalition in all 5 patients. Talocalcaneal coalition can cause posteromedial ankle impingement syndrome when the coalition is hypertrophic. The angle and thickness of the medial talus facet could be a simple index to diagnose this disorder.
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NewsBot · Feb 27, 2016

A Different Type of Talocalcaneal Coalition With Os Sustentaculum: The Continued Necessity of Revision of Classification.
Yun SJ et al
AJR Am J Roentgenol. 2015 Dec;205(6):W612-8

OBJECTIVE:
The objective of our study was to retrospectively determine the prevalence and image findings of extraarticular talocalcaneal coalition with os sustentaculum, a type of talocalcaneal coalition that does not appear in current classification systems, in patients with an imaging diagnosis of foot coalition.
MATERIALS AND METHODS:
This study was performed using a database query of radiology reports of ankle and foot CT or MRI examinations performed from August 2001 to November 2013. Eighty-one patients were identified through a keyword search of the database for "talocalcaneal coalition," "tarsal coalition," "coalition," or "os sustentaculum." Imaging features of CT or MRI findings were evaluated. Chart review was used to identify demographic information.
RESULTS:
Extraarticular talocalcaneal coalition with os sustentaculum was diagnosed in 13 patients (nine men, four women), which represents a prevalence of 16.0% (13/81) in all foot coalitions and 24.1% (13/54) in all talocalcaneal coalitions. Four of 13 patients underwent surgical resection, and histology was obtained in three patients. Nine patients who had no history of trauma were symptomatic and all patients with bone marrow edema at the coalition sites on MRI (n = 5) were also symptomatic. Coexisting extraarticular talocalcaneal coalition with os sustentaculum and intraarticular talocalcaneal coalition were observed in 11 of 13 patients.
CONCLUSION:
The os sustentaculum is a component of extraarticular talocalcaneal coalitions and as such is usually related to the presence of symptoms. If a patient with an os sustentaculum has symptoms in the medial talocalcaneal joint area, an extraarticular talocalcaneal coalition related to the os sustentaculum should be considered.
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NewsBot · Mar 26, 2016

Posteromedial subtalar coalitions: prevalence and associated morphological alterations of the sustentaculum tali
Sarah D. Bixby , Delma Y. Jarrett, Patrick Johnston, Susan T. Mahan, Paul K. Kleinman
Pediatric Radiology; 22 March 2016

Background
A variant form of subtalar coalition isolated to the posterior sustentaculum has been previously described, though its prevalence is not known and its relationship to the middle facet has not been characterized.
Objective
To determine the prevalence and morphological alterations of isolated posteromedial subtalar coalitions.
Materials and methods
Computed tomography (CT) images of the foot or ankle performed from 2004 to 2012 were reviewed and 97 patients (mean age: 13.3+/-2.9 years; range: 9-19 years) with subtalar coalition were identified. In 41 (42%) of these, the condition was bilateral, yielding a total of 138 subtalar coalitions. In the 33 patients where CT demonstrated isolated posteromedial subtalar coalitions, multiplanar reformats along the long axis of the sustentaculum tali were generated, from which the anteroposterior dimensions of the sustentaculum tali and middle facet were measured. Posterior sustentaculum measurements defining the posterior extension of the sustentaculum beyond the middle facet were directly measured by two radiologists. Ratios of middle facet to posterior sustentaculum measurements were calculated. Thirty-three patients undergoing CT for ankle fracture served as controls.
Results
Ninety-seven of 138 coalitions (70.2%) affected the middle facet and 2/138 (1.4%) involved the posterior facet. There were 39 (28.2%) posteromedial subtalar coalitions in 33 patients. Mean AP measurements of the middle facet and posterior sustentaculum in patients with posteromedial subtalar coalitions were 12.6 mm and 18.2 mm, respectively, compared to 16.6 mm and 9.2 mm in controls (P<0.001). Mean middle facet/posterior sustenaculum (MF/PS) ratios were 0.74 for posteromedial subtalar coalitions vs. 1.92 for controls (P<0.001).
Conclusion
Posteromedial subtalar coalitions comprise more than one-quarter of subtalar coalitions, and are associated with an intact, but shorter, middle facet and longer sustentaculum tali. This observation may aid in accurate diagnosis and management of this relatively common disorder.
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NewsBot · Jul 19, 2016

Surgical treatment of talocalcaneal coalition : Experience with 80 cases of pediatric or adolescent patients
Hamel J et al
Orthopade. 2016 Jul 12

INTRODUCTION:
There is still a controversial discussion on the treatment of talocalcaneal coalition with and without planovalgus deformity. From 2002-2014 80 cases of talocalcaneal coalition in children and adolescents under 18 years of age were surgically treated by J. Hamel. The objective of this study is a retrospective analysis, especially of unfavourable results.
METHODS:
Patients with minimum follow up of 12 months were included (35.7 months on average). In 31 cases treatment consisted of resection and fat-grafting (group 1), in 26 additional cases tarsal osteotomy was added because of planovalgus-deformity (group 2), and in 23 cases primary fusion of the talocalcaneal joint was performed (group 3).
RESULTS:
In group 1 one patient was lost to follow-up early with a severe peroneal spasticity and unknown further course. Two further patients still had remarkable pain after 15 months, and another patient had to undergo secondary fusion because of persistent pain. In group 2 secondary fusion was undertaken in two cases and offered in four other cases. In group 3 two patients still suffered from moderate tarsal pain, although complete fusion occurred; one of these patients underwent bilateral treatment. All other patients were pain free or nearly pain free on the last follow-up visit, with marked improvement in comparison to the preoperative situation.
DISCUSSION:
Surgical treatment of talocalcaneal coalition is successful in most cases in the short to medium follow-up, but unfavourable results are not uncommon and may require secondary fusion. Differential indication between resection, additional deformity correction, or primary fusion seems to be most important.
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NewsBot · Aug 16, 2016

Taking out the tarsal coalition was easy. But now the foot is even flatter. What now?

NewsBot · Sep 17, 2016

Incidence of Tarsal Coalition: An Institutional Magnetic Resonance Imaging Analysis
Jung-Han Kim, Heui-Chul Gwak, Chang-Rak Lee, Young-Jun Kim, Jeon-Gyo Kim, Sun-Joo Lee, Jeong-Han Lee, and Jun-Ho Park
J Korean Foot Ankle Soc. 2016 Sep;20(3):116-120. Korean.

Purpose
Tarsal coalition results from defects during the developmental stage and produes ankle pain and limitations in the range of motions. Its incidence has been reported to be 1%, but there has not been any reports with respect to Koreans. Therefore, we evaluated the prevalence of tarsal coalition in Koreans.

Materials and Methods
Between 2005 and 2014, we analyzed a total of 733 cases of foot and ankle magnetic resonance imaging (MRI) in our hospital. There were 391 men and 342 women. All MRI readings were read by a radiologist in our hospital. We classified the coalitions in accordance with the histological and anatomical characteristics, and calculated the prevalence in each group. Moreover, we tried to determine the prevalence of tarsal coalitions in accordance with sex, age, and proportion of the symptomatic tarsal coalitions.

Results
There were a total of 11 MRIs of tarsal coalition—9 talocalcaneal coalitions, 1 calcaneocuboidal coalition, and 1 calcaneonavicular coalition. Nine tarsal coalitions were observed in men and 2 in women.

Conclusion
Through this study, we found that the prevalence of tarsal coalition, including the asymptomatic patients, is similar to the previously known prevalence (1%). By getting more MRIs of the foot and ankle, we could better represent the prevalence of tarsal coalitions in Koreans.
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NewsBot · Sep 27, 2016

The Use of Cryo-Preserved Umbilical Cord Plus Amniotic Membrane Tissues in the Resection of Tarsal Coalition
D. Jeffrey Covell et al
Foot & Ankle Orthopaedics August 2016 vol. 1 no. 1

Introduction/Purpose: Tarsal coalition can be a common underlying cause of painful flatfoot deformity in adolescent and adult patient populations. When conservative options fail, surgical resection becomes the mainstay of treatment. Adequate resection leaves a void, often filled with bone wax, fat graft or adjacent muscle or tendon. Interposition grafting is designed to provide a physical barrier between the ends of the excised segment and deter recurrence or bony overgrowth. No definitive graft choice has been shown to be superior to another. The goal of this study was to evaluate the use commercially available umbilical cord plus amniotic membrane tissues as an interposition graft with functional and radiological outcomes at one year follow-up.
Methods: Retrospective review was performed of patients who had resection of tarsal coalition at our institution. Patients who had interposition of umbilical cord plus amniotic membrane tissues (Amniox Medical, Atlanta GA) at the site of the resection were included in this review. Postoperative data collection included VAS scores, Foot Function index scores, and radiographic review. Radiographic review included postoperative CT scans in all patients. Assessment of hindfoot ROM was noted on physical examination at last follow up visit.
Results: Fourteen patients (8 male and 6 female; median age 28.5 years at time of evaluation) were enrolled in the study. Of these patients, 7 were calcaneonavicular coalitions and 7 were talonavicular coalitions. Average follow up occurred at 18 months (range 9-32 months). Interposition of umbilical cord plus amniotic membrane tissues was performed at the site of the resection. Median improvement in pain visual analog score (VAS) was 89.75%, with no post-operative infection or wound complications. Post-operative CT scan review demonstrated evidence of osteoarthritis in two patients (one at talonavicular and one subtalar joint). Four of 14 patients (29%) were found to have recurrence at follow-up. The median post-operative Foot Function Index score was 46 (range 30-110) and 64% of patients had improvement in range of motion.
Conclusion: Based on radiological and functional outcomes at an average 19 month follow up, the interposition of umbilical cord plus amniotic membrane tissues after tarsal coalition resection appears to be a viable option in treating these patients. No adverse reactions were found and recurrence rate was noted to be 29%.
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NewsBot · Nov 12, 2016

Talocalcaneal coalition: A focus on radiographic findings and sites of bridging.
Lee SH, Park HJ, Yeo ED, Lee YK.
Indian J Orthop 2016;50:661-8

Background: Verifying the exact location of talocalcaneal (TC) coalition is important for surgery, but the complicated anatomy of the subtalar joint makes it difficult to visualize on radiographs. No study has used computed tomography (CT) or magnetic resonance imaging (MRI) to verify the radiological characteristics of TC coalition or those of different facet coalitions. Therefore, this study verified the radiological findings used to identify TC coalitions and those of different facet coalitions using CT and MRI.
Materials and Methods: Plain with/without weight bearing anteroposterior and lateral radiographs, CT, and MRI of 43 feet in 39 patients with TC coalitions were reviewed retrospectively. CT or MRI was used to verify the location of the TC coalition. Secondary signs for the presence of a coalition in the anteroposterior and lateral plain radiographs, including talar beak, humpback sign, duck-face sign, and typical or deformed C-sign, were evaluated. Three independent observers evaluated the radiographs twice at 6-week intervals to determine intraobserver reliability. They examined the radiographs for the secondary signs, listed above, and coalition involved facets.
Results: The average rates from both assessments were as follows: Middle facet 5%, middle and posterior facets 27%, and posterior facet 68%. The deformed C-sign is more prevalent in posterior facet coalitions. The posterior facet has the highest prevalence of involvement in TC coalitions, and the deformed C-sign and duck-face sign have high correlations with TC coalitions in the posterior subtalar facet.
Conclusion: A posterior facet is the most prevalent for TC coalition, and the C-sign is useful for determining all types of TC coalition.
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