Management of Complex Tarsal Coalition in Children

Hindfoot joint kinematics analysis after the resection of talocalcaneal coalition

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.

Foot pain in children and adolescents: a problem-based approach in musculoskeletal ultrasonography

Various etiologies and risk factors contribute to foot pain in children and adolescents, including conditions such as Kohler's disease, Sever's disease, Iselin's disease, rigid flat foot, accessory navicular, Freiberg's disease, sesamoiditis, os trigonum syndrome, and more. High-frequency musculoskeletal ultrasonography can show both the bone surface and the surrounding soft tissue clearly from various angles in real-time, thereby providing a higher level of detail that is helpful for identifying the etiology of foot pain and monitoring disease progression compared with other imaging modalities. This review provides an overview of the epidemiology, pathophysiology, clinical manifestations and characteristic ultrasonographic findings of select foot pain conditions in children and adolescents.

Ankle and Foot Deformities in Children

Ankle and foot deformity is one of the most common musculoskeletal disorders in children and a leading cause of functional impairment and diminished quality of life when not treated. A spectrum of conditions may produce foot and ankle deformities, with congenital disorders the most frequent cause, followed by acquired conditions. Congenital disorders include congenital talipes equinovarus or congenital clubfoot, metatarsus adductus, skewfoot, congenital vertical talus, and tarsal coalition.Some of these deformities are frequent and easily diagnosed based on clinical features, but clinical overlap between pathologies can be challenging. Thus imaging plays a paramount role in evaluating these patients. Radiographs are the first imaging modality of choice, but they may not be sufficient in infants due to the lack of ossification of the tarsal bones. Ultrasonography allows not only a detailed visualization of the cartilaginous structures but also permits a dynamic study of the foot and ankle. Computed tomography may be necessary in certain conditions such as tarsal coalitions.

Cuboid-Navicular Arthrodesis of the Foot After Arthroscopic Resection of Cuboid-Navicular Synchondrosis

Cuboid-navicular synchondrosis is a rare pathology that has historically been treated with open surgery. Open surgery poses complications and precludes satisfactory visibility during the operative treatment of these lesions. Arthroscopic portals typically limit the risk of complications and provide better visibility in small joints. We describe here an original technique of arthroscopic resection followed by cuboid-navicular arthrodesis.