Talocalcaneal coalition

NewsBot · Jul 3, 2023

Coalition excision and corrective osteotomies versus coalition excision and arthroereisis in management of pes planovalgus with talo-calcaneal coalition in adolescents: A randomized controlled trial
Awab Ali Mousa et al
Foot and Ankle Surgery; 28 June 2023

Background
Talocalcaneal coalition is the most common cause of rigid flat foot in adolescents. It presents with recurrent ankle sprains, foot and ankle pain, and foot deformity. Management is still controversial. Multiple options were utilized during the last 40 years, including coalition excision only or coalition excision with hind foot arthrodesis or corrective osteotomies. However, the effect of arthroereisis after coalition excision is still questionable.

Patients and Methods
Thirty feet in 28 patients with rigid flat foot due to talocalcaneal coalition, who presented to our institution between September 2018 and April 2020, were prospectively analyzed. Randomization was performed by random allocation using a computer-based system into two groups: group A for coalition excision and arthroereisis, group B for coalition excision and osteotomies. Functional and radiological outcomes and complications were recorded and analyzed using Statistical Package for the Social Sciences software.

Results
Thirty feet in 28 patients were included in the final analysis (15 feet in each group). One patient in each group had bilateral affection. The mean age was 14.5 years, and the mean follow-up duration was 24 months. At final follow-up, the mean AOFAS was 78.8±4.04 in group A and 76.73±4.66 in group B, while the FAAM scores were 80±5 and 79±3 in groups A and B, respectively. The complication rate was higher in group A, however with no statistical significance.

Conclusion
The combination of talocalcaneal coalition resection with either corrective osteotomies or arthroereisis had a significant improvement of functional and radiological outcomes in the management of rigid pes planovalgus.
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NewsBot · Jul 18, 2023

Coalition excision and corrective osteotomies versus coalition excision and arthroereisis in management of pes planovalgus with talo-calcaneal coalition in adolescents: A randomized controlled trial
Awab Ali Mousa et al
Foot Ankle Surg. 2023 Jun 28;S1268-7731(23)00122-4

Background: Talocalcaneal coalition is the most common cause of rigid flat foot in adolescents. It presents with recurrent ankle sprains, foot and ankle pain, and foot deformity. Management is still controversial. Multiple options were utilized during the last 40 years, including coalition excision only or coalition excision with hind foot arthrodesis or corrective osteotomies. However, the effect of arthroereisis after coalition excision is still questionable.

Patients and methods: Thirty feet in 28 patients with rigid flat foot due to talocalcaneal coalition, who presented to our institution between September 2018 and April 2020, were prospectively analyzed. Randomization was performed by random allocation using a computer-based system into two groups: group A for coalition excision and arthroereisis, group B for coalition excision and osteotomies. Functional and radiological outcomes and complications were recorded and analyzed using Statistical Package for the Social Sciences software.

Results: Thirty feet in 28 patients were included in the final analysis (15 feet in each group). One patient in each group had bilateral affection. The mean age was 14.5 years, and the mean follow-up duration was 24 months. At final follow-up, the mean AOFAS was 78.8 ± 4.04 in group A and 76.73 ± 4.66 in group B, while the FAAM scores were 80 ± 5 and 79 ± 3 in groups A and B, respectively. The complication rate was higher in group A, however with no statistical significance.

Conclusion: The combination of talocalcaneal coalition resection with either corrective osteotomies or arthroereisis had a significant improvement of functional and radiological outcomes in the management of rigid pes planovalgus.
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NewsBot · Aug 9, 2023

Coalition excision and corrective osteotomies versus coalition excision and arthroereisis in management of pes planovalgus with talo-calcaneal coalition in adolescents: A randomized controlled trial
Awab Ali Mousa et al
Foot and Ankle Surgery 28 June 2023

Background
Talocalcaneal coalition is the most common cause of rigid flat foot in adolescents. It presents with recurrent ankle sprains, foot and ankle pain, and foot deformity. Management is still controversial. Multiple options were utilized during the last 40 years, including coalition excision only or coalition excision with hind foot arthrodesis or corrective osteotomies. However, the effect of arthroereisis after coalition excision is still questionable.

Patients and methods
Thirty feet in 28 patients with rigid flat foot due to talocalcaneal coalition, who presented to our institution between September 2018 and April 2020, were prospectively analyzed. Randomization was performed by random allocation using a computer-based system into two groups: group A for coalition excision and arthroereisis, group B for coalition excision and osteotomies. Functional and radiological outcomes and complications were recorded and analyzed using Statistical Package for the Social Sciences software.

Results
Thirty feet in 28 patients were included in the final analysis (15 feet in each group). One patient in each group had bilateral affection. The mean age was 14.5 years, and the mean follow-up duration was 24 months. At final follow-up, the mean AOFAS was 78.8 ± 4.04 in group A and 76.73 ± 4.66 in group B, while the FAAM scores were 80 ± 5 and 79 ± 3 in groups A and B, respectively. The complication rate was higher in group A, however with no statistical significance.

Conclusion
The combination of talocalcaneal coalition resection with either corrective osteotomies or arthroereisis had a significant improvement of functional and radiological outcomes in the management of rigid pes planovalgus.
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NewsBot · Oct 24, 2023

How accurate is MRI for diagnosing tarsal coalitions? A retrospective diagnostic accuracy study
Adrian A Marth et al
Eur Radiol. 2023 Oct 19

Objectives: This study aimed to evaluate the diagnostic accuracy, inter-reader agreement, and associated pathologies on MR images of patients with confirmed TC.

Methods and materials: In this retrospective study, 168 ankle MRI exams were included, consisting of 56 patients with clinically or surgically confirmed TC and 112 controls without TC, matched for age and sex. Images were analyzed independently by three radiologists blinded to clinical information. The evaluation criteria included the presence, type, and location of TC, as well as associated pathologies. After calculating diagnostic accuracy and the odds ratio of demographic data and anatomic coalition type for associated pathologies, inter-reader agreement was assessed using kappa statistics.

Results: The majority of TCs were non-osseous (91.1%) and located at the calcaneonavicular (33.9%) or talocalcaneal joint (66.1%). Associated pathologies included adjacent and distant bone marrow edema (57.1% and 25.0%), osteochondral defect of the talar dome (OCD, 19.6%), and joint effusion (10.7%) and accessory anterolateral talar facet (17.9%). Talar OCD was associated with increased patient age (p = 0.03). MRI exhibited a cumulative sensitivity and specificity of 95.8% and 94.3% with almost perfect inter-reader agreement (κ = 0.895).

Conclusion: MRI is a reliable method for detecting tarsal coalition and identifying commonly associated pathologies. Therefore, we recommend the routine use of MRI in the diagnostic workup of patients with foot pain and suspected tarsal coalition.

Clinical relevance statement: MRI is an accurate and reliable modality for diagnosing tarsal coalitions and detecting associated pathologies, while improving patient safety compared to computed tomography by avoiding radiation exposure.
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NewsBot · Mar 28, 2024

TALOCALCANEAL COALITION CLASSIFICATIONS: A CRITICAL ANALYSIS REVIEW AND SUGGESTED NEW CLASSIFICATION SYSTEM WITH IMPLICATIONS FOR TREATMENT
Mark S. Myerson et al
Foot and Ankle Surgery 27 March 2024

Talocalcaneal coalitions (TCC) is the second most frequent tarsal coalition reported. Our aim was to review talocalcaneal coalition classifications and to propose a new classification emphasizing a therapeutic approach.

None of the classifications described for TCC mention the presence of flatfoot or valgus hindfoot, which are the key elements when defining the optimal treatment of this disease. We defined five clinical and radiological factors that would guide the choice of surgical treatment and based on these, we proposed a new classification system.
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NewsBot · Apr 24, 2024

Hindfoot joint kinematics analysis after the resection of talocalcaneal coalition
Junyo Boo et al
Gait & Posture Volume 111, June 2024, Pages 48-52

Background
The subtalar joint movement between the talus and calcaneus is restricted in patients with talocalcaneal coalition (TCC). When the motion of the subtalar joint is restricted, shock absorption in the foot decreases, leading to pain during walking. Resection methods to maintain subtalar motion by removing abnormal unions have been proposed. The purpose of this study was to analyze the joint kinematics of patients who underwent TCC resection and to quantitatively evaluate the results of the surgery based on the measured kinematics.

Methods
Joint kinematics of five patients with TCC were obtained using a biplane fluoroscopic imaging system and an intensity-based two-/three-dimensional registration method. The joint kinematics of the tibiotalar and subtalar joints and the tibiocalcaneal motion during the stance phase of walking were obtained. From the kinematics of the hindfoot joints, the inversion/eversion range of motion (ROM) of the patients before and after resection was statistically analyzed using the Wilcoxon signed-rank test to test whether TCC resection improved the ROM.

Results
During the loading response period, the eversion ROM of the subtalar joint and tibiocalcaneal motion significantly increased postoperatively. In addition, a significant postoperative increase was observed in the subtalar and tibiocalcaneal inversion ROM during the pre-swing period.

Significance
TCC resection surgery increased the ROM of the subtalar joint, which in turn contributed to the increase in tibiocalcaneal ROM. Increased subtalar and tibiocalcaneal ROM could result in increased shock attenuation and may be a contributing factor to pain relief during walking.
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NewsBot · Jun 14, 2024

Talocalcaneal coalition in the female adult skeleton from the archaeological site of Perlek-Dioksid, Serbia (10th - 12th centuries AD)
Veda Mikašinović et al
Source

In this case report, we will present a case of rare pathological condition, a talocalcaneal coalition, which was recorded in a female adult individual from the archaeological site of Perlek-Dioksid, dated in the period between 10th and 12th centuries AD. During the bioanthropological and paleopathological analyses it was noted the presence of a bilateral bony fusion of the calcaneus and talus of a female adult individual, suggesting an occurrence of talocalcaneal coalition. This was further confirmed by an X-ray examination. Talocalcaneal coalition (TC) occurs when adjacent tarsal bones, the calcaneus and talus, are partially or completely fused. A talocalcaneal coalition becomes symptomatic when, at the age of 12 to 15 years, a pre-existing coalition becomes ossified. In this case, TC was accompanied by degenerative changes of the spine and bilateral femoral neck anteversion. This condition did not require any form of health-related care for this person, although it probably caused occasional pain of varying intensity. This pathological condition is rarely described in bioarchaeological literature and it is, therefore, important to report every recorded case in order to improve our corpus of knowledge regarding such conditions.
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NewsBot · Aug 7, 2024

Talocalcaneal Coalition Resection with Local Fat Grafting and Flatfoot Reconstruction
Kira K Tanghe et al
JBJS Essent Surg Tech. 2024 Aug 6;14(3):e22.00060

Background: Talocalcaneal (TC) coalitions typically present in the pediatric population with medial hindfoot and/or ankle pain and absent subtalar range of motion. Coalition resection with fat interposition is well described for isolated tarsal coalitions1,2; however, patients with concomitant rigid flatfoot may benefit from additional reconstructive procedures. To address this, we employ the surgical technique of TC resection with local fat grafting and flatfoot reconstruction.

Description: This procedure is described in 3 steps: (1) gastrocnemius recession and fat harvesting, (2) TC coalition resection with local fat interposition, and (3) peroneus brevis Z-lengthening and calcaneal lateral column lengthening osteotomy with allograft. A 3 to 4-cm posteromedial longitudinal incision is made at the distal extent of the medial head of the gastrocnemius muscle. The gastrocnemius tendon is identified, dissected free of surrounding tissue, and transected. Superficial fat is then harvested from this incision before wound closure. A 7-cm incision is made from the posterior aspect of the medial malleolus to the talonavicular joint. The neurovascular bundle and flexor tendons are dissected carefully from the surrounding tissue as a group and protected while the coalition is completely resected, and bone wax and the local fat are utilized at the resection site to prevent regrowth of the coalition. An approximately 7-cm incision is then made laterally and obliquely following the Langer lines and centered over the lateral calcaneus. The peroneal tendons are released from their sheaths, and the peroneus brevis is Z-lengthened. A calcaneal osteotomy is performed about 1.5 cm proximal to the calcaneocuboid joint and angled to avoid the anterior and middle subtalar facet joints. Two Kirschner wires are inserted retrograde across the calcaneocuboid joint, and the calcaneal osteotomy is opened. A trapezoid-shaped allograft bone wedge is impacted, and the Kirschner wires are advanced across into the calcaneus. The lengthened peroneus brevis tendon is repaired, and the wound is closed in a layered fashion.

Alternatives: First-line treatment is nonoperative with orthotics and immobilization. Surgical options include coalition resection with or without calcaneal lengthening osteotomy, arthrodesis, or arthroereisis. Following coalition resection, various grafts can be utilized, including fat autografts, bone wax, or split flexor hallucis longus tendon3-6.

Rationale: This procedure addresses TC coalition with concomitant rigid flatfoot. Resection alone may increase subtalar motion but does not correct a flatfoot deformity. Historically, surgeons performed arthrodesis or arthroereisis, but these are rarely performed in young patients. In patients with coalitions involving >50% of the posterior facet or preexisting degenerative changes, arthrodesis may be indicated7.

Expected outcomes: Patients can expect improvement in pain and function8-11. Previous investigators reported improved patient satisfaction, improved range of motion, clinical and radiographic hindfoot correction, and an improved American Orthopaedic Foot & Ankle Society hindfoot score at the time of final follow-up8,9.

Important tips: Carefully free the neurovascular bundle from the surrounding soft tissue so that it can be carefully retracted away from the area of coalition resection.Utilize the interval between the posterior tibialis and flexor digitorum longus tendons to approach the coalition.Expose the medial wall of the coalition and perform a careful resection that avoids inadvertently diverging into the body of the talus or calcaneus.Place a smooth lamina spreader into the resected area and gently open the subtalar joint to confirm complete coalition resection.Place 2 retrograde wires across the calcaneocuboid joint before performing the osteotomy. Without this step, up to 50% of cases experience calcaneocuboid subluxation and/or rotation after the lateral column lengthening12.To determine the size of the allograft, place a lamina spreader into the osteotomy site to measure the width.If present, rigid supination of the forefoot must be corrected with a medial cuneiform plantar-based closing osteotomy.
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NewsBot · Aug 7, 2024

Tarsal Coalition: Surgical Management in the Young Athlete
Javier Masquijo, Florencia Turazza
HSS J. 2024 Aug;20(3):383-389

Tarsal coalition is an abnormal bony, cartilaginous, or fibrous bridge between 2 or more tarsal bones. Adolescent athletes with tarsal coalitions typically present with symptoms that include foot and/or ankle pain and limited range of motion. Loss of mobility can lead to abnormal loading, articular instability, deformity, and joint degeneration. Nonoperative management includes immobilization, physical therapy, and custom foot orthosis. Surgical options include coalition excision and fat graft interposition, foot realignment, or a combination of these. Surgical treatment requires evaluation of the coalition type, foot alignment, and degenerative changes in the adjacent joints.
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NewsBot · Aug 14, 2024

Talocalcaneal coalition classifications: A critical analysis review and suggested new classification system with implications for treatment
Mark S. Myerson et al
Foot and Ankle SurgeryVolume 30, Issue 6, August 2024, Pages 450-456

Talocalcaneal coalitions (TCC) is the second most frequent tarsal coalition reported. Our aim was to review talocalcaneal coalition classifications and to propose a new classification emphasizing a therapeutic approach. None of the classifications described for TCC mention the presence of flatfoot or valgus hindfoot, which are the key elements when defining the optimal treatment of this disease. We defined five clinical and radiological factors that would guide the choice of surgical treatment and based on these, we proposed a new classification system.
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NewsBot · Oct 1, 2024

CLINICAL CHARACTERIZATION OF PATIENTS WITH TARSAL COALITIONS
Enrique Fernández-Rojas et al
Rev Esp Cir Ortop Traumatol. 2024 Sep 27

Background: Tarsal coalitions are aberrant unions of two or more tarsal bones which may condition variable foot and ankle conditions. Their incidence is also variable but most frequently diagnosed coalitions are talocalcaneal and calcaneonavicular. This article aims to evaluate clinical and epidemiological characteristics of patients diagnosed with tarsal coalitions.

Materials and methods: Cross-sectional descriptive study of patients with tarsal coalitions from August 2007 to January 2020 in a private University Hospital in Madrid, Spain. Data on age, sex, type of coalition according to anatomical location and tissue type, laterality and hindfoot condition and symptoms were obtained and analyzed.

Results: Of the 57 patients identified (80 feet), there were 31 males (54.4%) and 26 females (45.6%). Average age was 36.9 years. The total number of coalitions was 85. There were 48 bilateral coalitions (56,5%). Fifty-two talocalcaneal coalitions (TCC) (61.2%), 32 calcaneonavicular coalitions (CNC) (37.6%) and 1 calcaneocuboid coalition (1.2%) were registered. Our series showed 36 osseous coalitions (42.4%) and 49 fibrocartilaginous coalitions (57.6%). When evaluated separately, 35 of the TCC were osseous (67.3%) and 17 were fibrocartilaginous (32.7%); 1 of the CNC was osseous (3.1%) and 31 were fibrocartilaginous (96.9%).

Discussion: In our review, TCC was the most frequent subtype, with the majority being the bony in nature. In the distribution according to sex, a higher incidence of males is found within the CCN group (Fisher's Exact test, p = 0.032). Some of the results obtained are different from what was previously reported in the literature, which gives rise to new studies that explain this difference in our population.
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NewsBot · Oct 2, 2024

Massive tarsal coalition with extended tarsometatarsal coalition in a child: a case report
Lei Yang et al
Front Pediatr. 2024 Sep 11:12:1362142

Tarsal coalition refers to the union of two or more tarsal bones, which mostly involves the calcaneonavicular and talocalcaneal joints; it is rarely found in multiple unions or unions extended to the metatarsal bones. Nearly 50% of cases occur bilaterally and can be either symmetrical or asymmetrical. We described a rare case of symmetrically bilateral tarsal coalitions involving all the tarsal bones, except for the medial cuneiform, and extending to the fourth metatarsal bones in a 5-year-old boy. This patient exhibited no obvious symptoms and had not received any further intervention, only regular follow-up. To our knowledge, this is the first report of this type of massive coalition involving the union of six tarsals and one tarsometatarsal bilaterally.
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NewsBot · Oct 10, 2024

Morphological characteristics of talocalcaneal coalitions: Anatomical observation, finite element analysis and clinical application
Guanyu Hu et al
Asian Journal of Surgery; 3 October 2024

Background
The intricate anatomical structure of talocalcaneal coalitions (TCCs) presents significant challenges for clinicians in both diagnosis and treatment. This study aimed to investigate the anatomy, imaging characteristics, and biomechanical properties of TCCs, providing essential references for contemporary clinical diagnosis, treatment, scientific research, and education regarding TCCs.
Methods
The morphologies of TCCs were examined and classified in intact dry osseous specimens from 131 Asian adults. The imaging characteristics of TCCs were summarized by carefully observing the X-rays and CT scans. Additionally, finite element models of TCCs were established and validated, allowing for the simulation and analysis of stress and strain.
Results
The TCCs were primarily located in the region between the posterior end of sustentaculum tali (ST), the medial port of the tarsal canal, and the medial edge of the posterior talar articular surface (PTF). In comparison to specimens with cartilage and ligament connections, the medial tubercle of osseous connections exhibited significant inward and downward protrusion, while the ST was longer and thicker. Statistically significant differences were noted in the widths of the calcaneus and talus, as well as in the thickness and length of the ST (P < 0.05). CT imaging provided an accurate determination of TCCs’ locations, while X-rays revealed the presence of the “C sign” and “duck beak sign” in all osseous connection specimens. Finite element model analysis indicated that stress was primarily concentrated at the osseous connection, which also reduced displacement of the subtalar joint.
Conclusions
The comprehension of the precise location, anatomical morphological characteristics, imaging features and finite element mechanical properties of TCCs is instrumental in enhancing the diagnosis and treatment of TCCs.
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NewsBot · Oct 15, 2024

The Predictability of Clinical Findings and Radiographs for Detecting Tarsal Coalition
Kianna D Nunally et al
J Pediatr Orthop. 2024 Oct 15.

Introduction: Tarsal coalition is a disorder of the foot characterized by the abnormal union between 2 or more of the tarsal bones. A minority of patients will develop pain and limited motion when reaching adolescence, for whom surgical resection of the coalition may be necessary. The diagnostic value of clinical and radiologic signs remains unclear. The aim of this study is to assess the predictive value of clinical symptoms and plain x-rays to diagnose tarsal coalition in symptomatic patients.

Methods: We performed a retrospective chart review of patients with clinical suspicion of tarsal coalition between January 2011 and November 2019. Patient demographic data; clinical data on pain, limited motion, peroneal spasm, recurrent, or previous trauma; and radiologic data on the presence and type of coalition were collected. Multivariable general estimating equations analysis was used to assess associations between demographic and clinical characteristics and the likelihood of a positive coalition diagnosis.

Results: The study cohort was 336 patients (672 feet) with a mean age of 13 years and a 1:1 sex distribution. Thirt-eight percent of feet were diagnosed with a coalition of which 53% were talocalcaneal and 41% were calcaneonavicular. Coalitions were significantly more common in younger patients, males (OR 1.66, P=0.04), patients with lower BMI (OR 0.96, P=0.045), and patients who presented with painful feet (OR 1.59, P=0.04) or feet with limited motion (OR 7.49, P<0.001). Diagnostic utility of plain x-ray compared with CT diagnosis yielded a sensitivity of 76% and a specificity of 94%, with higher sensitivity (90%) in calcaneonavicular coalitions than in talocalcaneal (66%).

Discussion: Our study shows that limited subtalar movement, male sex, and low BMI have a high predictive value for tarsal coalition in symptomatic patients. Classic clinical findings that were not predictive of coalition in our cohort of symptomatic patients included peroneal spasm, recurrent ankle sprains, and recent trauma. Plain x-rays offer a reliable alternative to CT for diagnosis, especially for calcaneonavicular coalitions.
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NewsBot · Oct 17, 2024

Comparative analysis of clinical outcomes of talocalcaneal coalition resection: subtalar joint middle and posterior facet involvement versus isolated posterior facet involvement - a retrospective cohort study
Zhenyu Wang et al
J Orthop Surg Res. 2024 Oct 15;19(1):657

Background: Despite coalition resection being the preferred treatment for talocalcaneal coalition (TCC), postoperative complications, suboptimal functional recovery, and recurrence risks remain challenges. Although current TCC classification systems guide personalized surgical plans, the impact of middle and posterior facet coalitions on TCC resection surgery's effectiveness is still poorly understood. Therefore, this study aims to compare the clinical outcomes of TCC patients with and without involvement of the subtalar joint's (STJ) middle and posterior facets undergoing coalition resection to explore the potential impact of these coalitions on surgical outcomes.

Methods: We conducted a retrospective study on 115 patients who underwent coalition resection surgery due to symptomatic TCC between November 2009 and February 2023. According to preoperative CT scan results, patients were divided into an isolated posterior facet coalition (P-type) group and a middle-posterior facet coalition (MP-type) group. Demographic characteristics (including age, sex, body mass index (BMI), follow-up time, and medical history duration), pre-and postoperative assessments (including Visual Analog Scale (VAS), American Orthopaedic Foot & Ankle Society (AOFAS) score, Pain Interference (PI) and Physical Function (PF) scores from the Patient-Reported Outcomes Measurement Information System (PROMIS)), as well as postoperative self-assessment of efficacy (excellent, good, fair, poor) and hindfoot stiffness, were compared between the two groups. Postoperatively, TCC recurrence was evaluated through imaging follow-up examinations.

Results: 69 patients meeting the inclusion criteria were included, with 30 patients in the P-type group and 39 in the MP-type group. There were no statistically significant differences between the two groups in demographic characteristics (P<0.05). There were also no statistically significant differences between the two groups in preoperative VAS score, AOFAS score, PI score, and PF score. However, postoperatively, there were statistically significant differences between the two groups in VAS score (1(1,1.5) vs. 2(1,2), P<0.01), AOFAS score (92.5(87,96.5) vs. 82(69.5,87), P<0.01), PI score (39(39,43) vs. 39(39,51), P = 0.014), PF score (73(61,73) vs. 55(51,73), P = 0.001), fair or poor outcome (4(13%) vs. 14(35.9%), P = 0.034), and hindfoot stiffness (3(10.3%) vs. 16(37.2%), P = 0.011). There was no statistically significant differences in the recurrence rate between the two groups postoperatively (0(0%) vs. 3(7.69%), P = 0.252).

Conclusion: Even with complete coalition resection during surgery and rehabilitation following standardized protocols, the surgical outcomes in MP-type TCC patients are still inferior to those in P-type patients.
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NewsBot · Oct 19, 2024

Criteria for surgical decision-making in talocalcaneal tarsal coalitions
Vincent S. Mosca MD, Javier Masquijo MD
Journal of the Pediatric Orthopaedic Society of North America
Volume 7, May 2024, 100048

Assessment and management of talocalcaneal middle facet tarsal coalitions present a complex orthopaedic challenge. Various studies have attempted to establish guidelines for surgical intervention based on coalition size and hindfoot alignment. Our paper reviews the historical focus on coalition size, suggesting instead that posterior facet health is a more appropriate consideration for surgical decision making. Additionally, we challenge the traditional method for evaluating hindfoot alignment and propose a more accurate evaluation method. This critical review intends to highlight flaws in historical literature, aiming to trigger a reevaluation of the criteria for surgical intervention in talocalcaneal tarsal coalitions and promote future research studies driven by data and scientifically validated methodologies.
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NewsBot · Oct 20, 2024

Total Arthroscopic Resection of the Talocalcaneal Coalition in Adults: Key Points of Surgical Technique
Yiyuan Sun et al
Orthop Surg. 2024 Oct 19

Objective: Potential disadvantages of open technique for talocalcaneal coalition (TCC) include a risk of wound infection, opioid drug dependence, and prolonged hospitalization. The purpose of this study was to retrospectively evaluate the effectiveness and safety of endoscopic resection of the TCC.

Methods: A retrospective study from June 2019 to February 2023was conducted on 16 consecutively admitted patients who were diagnosed by imaging to have TCC for whom conservative treatment had failed and who undergone arthroscopic resection. The mean age of this cohort was 31.56 ± 10.39 years (range, 16-57 years). The mean follow-up period was 38.93 ± 15.69 months (range, 11-59 months). The site of the coalition, comorbidities, satisfaction with treatment, visual analog scale (VAS), and American Orthopedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot scale scores were evaluated pre- and postoperatively. Preoperative magnetic resonance imaging (MRI) scans were used to categorize the coalition according to the Lim classification. Postoperative computed tomography (CT) scans were used to assess recurrence. The distribution of TCC cases according to the Lim classification was type I in one case, type II in four cases, and type III in 11 cases.

Results: The site of coalition involved the middle facets in seven patients, the posterior facets in three patients, and both the above sites in six patients. All patients underwent total arthroscopic resection of TCC. An auxiliary mini-incision was made for three patients due to serious tibial nerve compression. Radiographics showed that the coalition disappeared and pain was relieved postoperatively. The mean VAS score decreased from 4.31 ± 1.54 to 1.81 ± 0.98 points (p < 0.001). The mean AOFAS ankle-hindfoot score improved from 65.56 ± 5.82 to 87.31 ± 6.30 points (p < 0.001). Fifteen patients were satisfied with the procedure, and one patient experienced numbness after surgery. No recurrence was reported based on CT scan and clinical results up to the end of the study.

Conclusion: Surgical reconstruction employing total arthroscopic resection of TCC can achieve significant functional and radiographic improvements and symptom relief in selected patients with TCC. Auxiliary mini-incisions were necessitated in complex situations.
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NewsBot · Oct 20, 2024

Innovative Surgical Treatment of Tarsal Coalition in Flatfoot: Resection and Interposition of Synthetic Membrane, flexible Bioresorbable Polymers Film, as Adhesion Barrier and subtalar arthroeresis. Up to Nine Years Follow-up
L. Peretto et al
Foot and Ankle Surgery 18 October 2024

Tarsal coalition can be a long term severely disabling condition. For symptomatic cases with flatfoot surgical resection of coalition and subtalar arthroeresis represents the most common treatment. Literature reports variable outcomes and recurrence. The aim was to achieve optimal correction with no recurrence. This retrospective study presents, reporting results, an innovative technique that provides numerous advantages and improved outcomes.
Nineteen patients suffering from painful flatfoot from tarsal coalition were, consecutively, surgically treated by resection of tarsal coalition with interposition of a synthetic flexible bioresorbable polymers membrane as an adhesion barrier and by subtalar arthroeresis. AOFAS scores were used to rate the clinical severity and X-ray/ CT to evaluate the extent of tarsal coalition. Patient’s age at time of surgery ranged from 12 to 21.The period examined runs from November 2010 to November 2019.
Results were evaluated (up to 9 years follow-up) clinically by AFOAS scores and radiologically by X-ray/CT. AOFAS scores improved in all patients with significant (p<0.01) pain reduction or disappearance, corrected alignment and increased function, biomechanics of the foot and mobility. X-ray showed no recurrence of coalition in all but one case. There were no complications and patients reported a significant improvement in quality of life.
Our study shows that surgical resection of coalition, and correction of flatfoot by subtalar arthroeresis, with the innovative use of a flexible bioresorbable polymers membrane as an adhesion barrier, obtained excellent overall results and importantly prevented recurrence. We believe this technique represents a great option.
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NewsBot · Oct 22, 2024

Talocalcaneal Coalition
Miller, Hailey G.; Arbel, Vered; Gottfeld, David W.; and Amasay, Tal (2024)
International Journal of Exercise Science: Conference Proceedings: Vol. 15: Iss. 4, Article 29.

CASE HISTORY: A 13-year-old male lacrosse athlete presented with gradual onset right ankle pain. Symptoms began at age ten, including multiple ankle sprains. The physician suspected plantar fasciitis and advised gel inserts, NSAID pain relievers, and physical therapy to no avail. The pain persisted as sports became more demanding. His performance continued to decrease, and gait became labored and disjointed, with an occasional limp. PHYSICAL EXAM: Lower extremity examination showed no varus or valgus deformities in the coronal plane. The symptomatic foot dorsiflexion was 20/35, with the knee flexed and extended. Manual strength test scores for plantarflexion, dorsiflexion, inversion, and eversion were 5/5. No hindfoot motion was observed. Lateral lunge test exhibited abduction of the foot with hip external rotation. Labored gait and a lack of coordination upon ground impact were observed during running. DIFFERENTIAL DIAGNOSES: Subtalar Joint Fracture, Calcaneal Stress Fracture, Achilles Tendonitis, Plantar Fasciitis. TESTS & RESULTS: A multiplanar MRI revealed a fibrous coalition of the talocalcaneal facet (TC). Medial facet was conjoined. Mild sprains were observed for both the anterior talofibular and calcaneofibular ligaments. Joint effusion from stress-related mild osseous edema was found at the calcaneus. FINAL DIAGNOSIS: Talocalcaneal coalition DISCUSSION: TC is a fibrous connection between the talus and calcaneal bone. The coalition locks the hindfoot in the valgus position. The deformity usually forms around 13-14 weeks of fetal development, and 75% of TC cases are asymptomatic until adolescence. TC accounts for 45% of all tarsal coalitions and is often bilateral. OUTCOME OF THE CASE: Surgical excision of fibrous coalition with autograft buttock fat was performed, followed by four months of physical therapy. Rehabilitation started with aquatic therapy. After four weeks, he had a normal gait and progressed to unilateral movements. Followed by reactive, plyometrics, and unpredictable loads training. RETURN TO ACTIVITY AND FURTHER FOLLOW-UP: After four months, the athlete returned to sport at a pre-operation performance level and continued to show improvement.
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NewsBot · Nov 5, 2024

Resection of Talocalcaneal Coalition With
Calcaneal Lengthening Osteotomy: Short-toIntermediate-Term Results
Michael Zaidman , Eden Weisstub , Vladimir Goldman , Naum Simanovsky
Source

Introduction: The optimal surgical strategy for symptomatic tarsal coalition in pediatric patients remains
debated. This study assessed the clinical and radiographic outcomes of addressing symptomatic
talocalcaneal coalition through a combination of coalition resection and calcaneal lengthening osteotomy.
Materials and methods: We retrospectively reviewed cases of 10 children (11 feet) with symptomatic
talocalcaneal tarsal coalition and painful flat feet who were treated between 2017 and 2019. All underwent
calcaneal lengthening osteotomy (CLO) and coalition resection (RC). In half of the cases, the Achilles
tendon was lengthened, and two children underwent medial plication. We analyzed demographic, clinical,
and radiographic data, including CT scans for coalition confirmation and joint evaluations. Pre- and
postoperative radiographic measurements and American Orthopedic Foot and Ankle Society (AOFAS) AnkleHindfoot Score assessed outcomes.
Results: The cohort, averaging 13.9 years at surgery, showed significant deformity correction. At follow-up
(mean 54 months), six children were pain-free, and four experienced mild pain after intense activities.
AOFAS scores were excellent or good. Complications included one superficial infection and mild forefoot
supination in two children. No additional surgeries were needed.
Conclusion: Resection of talocalcaneal coalition combined with CLO effectively corrects rigid flat foot and
alleviates pain, providing reliable outcomes in symptomatic cases.
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NewsBot · Nov 5, 2024

Radiographic Measurements of Pes Planovalgus Do Not Predict Clinical Outcomes in Tarsal Coalition Excision
Rushin, Claire et al
Journal of Pediatric Orthopaedics ():10.1097/BPO.0000000000002861, October 30, 2024. | DOI: 10.1097/BPO.0000000000002861

Objective:
Many patients who undergo tarsal coalition excision have persistent postoperative pain. Most studies have utilized cat scan (CT) scan parameters of pes planovalgus and heel valgus but have found this to be an inconsistent predictor of outcomes. Plain radiographic parameters have been less utilized in trying to predict outcomes after coalition excision. Radiographic talonavicular coverage angle correlates with pain in patients with flexible pes planovalgus (PPV) but has not been studied in tarsal coalition population. Furthermore, foot alignment is not understood to change after simple coalition excision. The purpose of this study was to compare plain radiographic parameters, including talonavicular coverage angle, with pain after tarsal coalition excision, as well as compare preoperative and postoperative weight-bearing radiographs.

Methods:
Seventy-seven feet that underwent excision of the tarsal coalition had clinical outcomes and radiographic data collected >1 year postoperatively. Measures of PPV on preoperative and postoperative weight-bearing radiographs and CT scans were evaluated.

Results:
Patients were an average of 13 years old at excision. Of the total, 65% had calcaneonavicular (CN) coalitions, whereas the remainder had talocalcaneal coalitions. All patients had significant postoperative improvement in clinical outcomes but 34% (13/38) had continued pain at the most recent follow-up, more so in talocalcaneal than CN coalitions (55% vs 26%, P < 0.001). The subset with CN coalitions had more severe preoperative PPV but greater postoperative PPV improvement. Except for a weak correlation between radiographic weight-bearing (anterior-posterior) talus-first metatarsal angle and pain with activity (r = -0.54), there were no other correlations between preoperative radiographic parameters and clinical outcomes. Heel valgus on CT did not correlate with radiographic measurements of PPV or pain.

Conclusions:
We did not find a correlation of radiographic PPV with persistent pain after tarsal coalition excision. We did find improvement in radiographic PPV in CN coalitions after treatment with simple excision. Heel valgus on CT was not a useful metric for evaluating PPV in the setting of a tarsal coalition
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NewsBot · Nov 13, 2024

Tarsal Coalition Resection in Children: Is it Effective?
Mitzi L Williams et al
Source

Tarsal coalitions in children are a group of disorders that typically present as a rigid flatfoot deformity. Operative treatment generally consists of resecting the coalition alone or resection plus flatfoot reconstructive procedures. The purpose of this study was to evaluate the rate and risk factors for complications, including infection, recurrence, and reoperation, following the surgical management of tarsal coalitions in children.
This is a retrospective cohort study on the surgical outcomes of pediatric tarsal coalitions alone or in combination with adjunctive procedures. This study was conducted between 01/01/2008 and 12/31/2019 and utilized electronic health records and chart review was performed to describe patient demographic, clinical, perioperative characteristics, and whether patients have subsequent foot and ankle procedures after the index resection surgery.
The study cohort included 165 feet belonging to 144 patients. The age range at time of surgery was 12 years of age (11-14). Of the 165 feet, 18 (10.9%) experienced a postoperative complication, including six infections of which two required reoperation, six recurrences all requiring reoperation, and six reoperations not due to recurrence. Patients with a postoperative complication demonstrated increased age (13.9 years vs 12.4 years, p=0.007), obesity (33.3% vs 13.6%, p=0.026), and/ or preoperative hindfoot valgus deformity (33.3% vs 7.5%, p=0.004).
The overall postoperative complication rate was 10.9%. Results of this study provided important information for providers as they discuss different treatment approaches and anticipated outcomes with patients and their families.
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Talocalcaneal coalition

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The Double Medial Malleolus: A New Physical Finding in Talocalcaneal Coalition

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Accuracy of online info on tarsal coalition

Tarsal Coalition in my son's foot..advice??

imaging for possible tarsal coalition

Coalitions leading to fractures

Metatarsal coalition

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Talocalcaneal coalition

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The Double Medial Malleolus: A New Physical Finding in Talocalcaneal Coalition

Tarsal-carpal coalition syndrome

Accuracy of online info on tarsal coalition

Tarsal Coalition in my son's foot..advice??

imaging for possible tarsal coalition

Coalitions leading to fractures

Metatarsal coalition

Share This Page

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