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De Pellegrin M, Marcucci L, Brogioni L, Fracassetti D. Resection of Calcaneonavicular and Talocalcaneal Coalitions With Surgical Correction of the Hindfoot Valgus Deformity in One Step. FOOT & ANKLE ORTHOPAEDICS 2024; 9:24730114241233598. [PMID: 38516059 PMCID: PMC10956163 DOI: 10.1177/24730114241233598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024] Open
Abstract
Background Calcaneonavicular (CNC) and talocalcaneal (TCC) coalitions are the most common cause of rigid flatfoot in children. After resection, correction of the most frequent valgus-hindfoot deformity usually requires a second-step surgery. We report results of a retrospective study of patients treated with a one-step correction. Methods Between 2008 and 2019, data were collected on 26 patients (19 male, 7 female) affected by CNC (n = 18) and TCC (n = 13), all with rigid symptomatic flatfeet. Average age at surgery was 12.5 ± 1.1 (SD) years (range, 9.8-15.2). All patients (26/26) underwent resection, 20 of 26 underwent at the same time subtalar extraarticular screw arthroereisis (SESA) for correction of residual hindfoot valgus deformity. Pre- and postoperative talocalcaneal angle according to Costa Bartani and Talar inclination angle in weightbearing were measured. Twenty-five of 26 patients had postoperative American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score. Results Pre- and postoperative talocalcaneal average angle for CNC was respectively 141.5 ± 7.7 degrees and 130.5 ± 5.2 degrees (P < .0001) and 143.7 ± 7.7 degrees and 129.7 ± 7.0 degrees (P < .0001) for TCC. Talar inclination average angle for CNC was 29.2 ± 5.3 degrees and 19.3 ± 1.6 degrees (P < .0001) and 31.2 ± 6.4 degrees and 21.4 ± 3.4 degrees (P < .0001) for TCC. Average follow-up (FU) was 4.7 ± 3.0 years (range, 6 months-11.9 years, median 4.9 years), with a mean age at FU of 17.2 ± 5.8 (SD) years (min 12.1, max 25.3, median 16.8 years). The mean AOFAS ankle-hindfoot score for CNC and for TCC was 96.6 (range 83-100) for resection and valgus correction as one-step procedure with no statistical difference (P = .5) between CNC and TCC. No patients had additional surgery for complications or recurrence. Conclusion Symptomatic rigid flatfeet affected by CNC and TCC treated with coalition resection and minimally invasive subtalar arthroereisis (SESA) for residual hindfoot valgus correction in one step in adolescent age achieved good to excellent results in all cases. Further surgery to correct malalignment was avoided. Level of Evidence Level IV, retrospective study.
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Affiliation(s)
| | - Lorenzo Marcucci
- Azienda Ospedaliera Universitaria Integrata Verona Sede di Borgo Trento, Verona, Italy
| | - Lorenzo Brogioni
- Azienda Ospedaliera Universitaria Integrata Verona Sede di Borgo Trento, Verona, Italy
- San Raffaele Hospital, Milano, Italy
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Vergillos Luna M, Khal AA, Milliken KA, Solla F, Rampal V. Pediatric Flatfoot: Is There a Need for Surgical Referral? J Clin Med 2023; 12:jcm12113809. [PMID: 37298004 DOI: 10.3390/jcm12113809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 05/29/2023] [Accepted: 05/30/2023] [Indexed: 06/12/2023] Open
Abstract
Pediatric foot deformities are a common finding, concerning up to 44% of preschool aged children. The absence of accepted international guidelines, as well as heterogeneity in definitions and measurements, makes management of pediatric flatfoot a challenge, and decisions surrounding specialized care referral confusing and biased. The objective of this narrative review is to provide guidance to primary care physicians treating these patients. A non-systematic review of the literature regarding the development, etiology, and clinical and radiographic assessment of flatfeet using the PubMed and Cochrane Library databases was performed. The exclusion criteria for the review were adult populations, papers detailing the outcome of a specific surgical procedure, and publications prior to 2001. The included articles showed great heterogeneity in definition and proposed management, which makes the study of pediatric flatfoot challenging. Flatfoot is a common finding in children under 10 years old, and should not be considered pathological unless stiffness or functional limitation are present. Surgical referral should be reserved to children with stiff or painful flatfoot, while simple observation is indicated for flexible, asymptomatic flatfeet.
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Affiliation(s)
- Manuel Vergillos Luna
- Department of Orthopedics, Regina Montis Regalis Hospital, 12084 Mondovì, Italy
- Department of Orthopedics, Lenval University Children's Hospital, 06200 Nice, France
| | - Adyb-Adrian Khal
- Department of Orthopedics, Lenval University Children's Hospital, 06200 Nice, France
| | - Kara A Milliken
- Department of Orthopedics, Lenval University Children's Hospital, 06200 Nice, France
| | - Federico Solla
- Department of Orthopedics, Lenval University Children's Hospital, 06200 Nice, France
| | - Virginie Rampal
- Department of Orthopedics, Lenval University Children's Hospital, 06200 Nice, France
- Laboratoire Motricité Humaine Expertise Sport Santé, Unité de Formation et Recherche Sciences et Techniques des Activités Physiques et Sportives, 06205 Nice, France
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3
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Zhang J, Wang C, Li X, Fu S, Gu W, Shi Z. Application of mixed reality technology in talocalcaneal coalition resection. Front Surg 2023; 9:1084365. [PMID: 36684274 PMCID: PMC9852772 DOI: 10.3389/fsurg.2022.1084365] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 12/05/2022] [Indexed: 01/08/2023] Open
Abstract
Objectives With positive outcomes recorded, the mixed reality (MR) technology has lately become popular in orthopedic surgery. However, there are few studies that specifically address the utility of MR in talocalcaneal coalitions (TCC) resection. Our goal in this retrospective study is to assess certain data while examining the viability of using MR to treat TCC resection. Methods Six consecutive patients with TCC diagnosed by computed tomography (CT) for which nonoperative therapy had failed and MR system assisted TCC resection were included in this study from March 2021 to December 2021. The feasibility and accuracy of TCC resection were assessed by post-operation radiography. The American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score and visual analog scale (VAS) score were used to assess the recovery condition and pain level pre- and post-operation. Results The surgeon can accurately resect the TCC according to the preoperatively determined range by superimposing the holographic model with the actual anatomy of the TCC using an MR system. Additionally, no additional x-ray was necessary while operating. Mean follow-up was 10.3 months, with a minimum of 6 months. There is a significant difference between the preoperative AOFAS score of 53.4 ± 3.8 and the 6-month follow-up AOFAS score of 97.3 ± 2.2 (p < 0.05). There is also a significant difference between the preoperative VAS score of 8.1 ± 0.7 and the 6-month follow-up VAS score of 1.7 ± 0.4 (p < 0.05). All individuals had clinical subtalar mobility without stiffness following surgery. Conclusion While the TCC resection operation is being performed, the application of MR technology is practicable, effective, and radiation-free, giving surgeons satisfactory support.
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Affiliation(s)
- Jieyuan Zhang
- Department of Orthopedic Surgery, Shanghai Sixth People’s Hospital, Shanghai, China
| | - Cheng Wang
- Department of Orthopedic Surgery, Shanghai Sixth People’s Hospital, Shanghai, China
| | - Xueqian Li
- Department of Orthopedic Surgery, Shanghai Sixth People’s Hospital, Shanghai, China
| | - Shaoling Fu
- Department of Orthopedic Surgery, Shanghai Sixth People’s Hospital, Shanghai, China
| | - Wenqi Gu
- Department of Orthopedic Surgery, Shanghai Sixth People’s Hospital, Shanghai, China,Department of Orthopedic Surgery, Shanghai Sixth People’s Hospital East Campus, Shanghai, China,Correspondence: Zhongmin Shi Wenqi Gu
| | - Zhongmin Shi
- Department of Orthopedic Surgery, Shanghai Sixth People’s Hospital, Shanghai, China,Correspondence: Zhongmin Shi Wenqi Gu
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Muacevic A, Adler JR, Young SM, Ray J, Shah A, Conklin MJ. A Review of Pediatric Heel Pain. Cureus 2023; 15:e34228. [PMID: 36852370 PMCID: PMC9960861 DOI: 10.7759/cureus.34228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2023] [Indexed: 01/28/2023] Open
Abstract
The objective of this review article is to provide orthopaedic surgeons and general practitioners a reference and guidance for the evaluation and workup of heel pain in pediatric patients. The authors performed a comprehensive literature search to review the etiologies and management of heel pain in patients <18 years of age. Relevant studies in Medline/PubMed and EMBASE were searched from inception to March 3, 2022 using medical subject headings and text words without limitations on language or study type. The initial search utilized the following Boolean operators: (children) AND (heel pain); (pediatric) AND (heel pain). Heel pain in the pediatric population is usually a benign condition. Sever's apophysitis is the most common etiology of heel pain in pediatric patients. Most causes of heel pain in the pediatric population do not require imaging or extensive workup. However, providers must maintain a high index of suspicion for symptoms that could indicate a more severe pathology.
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Affiliation(s)
- Alexander Muacevic
- Orthopaedic Surgery, University of Alabama at Birmingham School of Medicine, Birmingham, USA
| | - John R Adler
- Orthopaedic Surgery, University of Alabama at Birmingham School of Medicine, Birmingham, USA
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Anastasio AT, Peairs EM, Grant C, Kim BI, Duruewuru A, Adams SB. Fracture through Pre-Existing Tarsal Coalition: A Narrative Review. CHILDREN (BASEL, SWITZERLAND) 2022; 10:children10010072. [PMID: 36670623 PMCID: PMC9857168 DOI: 10.3390/children10010072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 12/21/2022] [Accepted: 12/27/2022] [Indexed: 12/31/2022]
Abstract
Tarsal coalitions are abnormal fibrous or bony connections between the tarsal bones of the foot. While not always symptomatic, coalitions can cause pain, alterations in forefoot and hindfoot morphology, and alterations in foot and ankle biomechanics. Previous research has described the association of tarsal coalitions with fractures of the lower extremity. Multiple reports of acute fracture in the presence of tarsal coalition have been presented, as have reports of stress fractures of the foot and ankle with concomitant coalition, insidious in onset and thought to be related to aberrancies in foot and ankle biomechanics. The purpose of this review is to discuss the biomechanics seen in tarsal coalitions and to describe reports of fracture occurring concomitantly with tarsal coalitions. We will discuss diagnostic options and treatment approaches in the setting of fracture with preexisting tarsal coalition.
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Affiliation(s)
- Albert T. Anastasio
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC 27705, USA
| | | | - Caitlin Grant
- Duke University School of Medicine, Durham, NC 27705, USA
| | - Billy I. Kim
- Duke University School of Medicine, Durham, NC 27705, USA
| | | | - Samuel B. Adams
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC 27705, USA
- Correspondence:
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Duffaydar H, Elmajee M, Dermanis AA, Hussain S, Pillai A. Post-interventional Outcomes in the Management of Adult Calcaneonavicular Coalitions: A Systematic Review. Cureus 2022; 14:e31253. [DOI: 10.7759/cureus.31253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2022] [Indexed: 11/09/2022] Open
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Bagley C, McIlhone S, Singla N, Berkeley R, O’Donnell P, Tennant S, Saifuddin A. MRI for paediatric flatfoot: is it necessary? Br J Radiol 2022; 95:20210784. [PMID: 34919445 PMCID: PMC9153719 DOI: 10.1259/bjr.20210784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE To determine the additional benefit of MRI for children with flatfoot deformity assessed with weight-bearing radiographs in a specialist paediatric orthopaedic unit. METHODS AND MATERIALS Patient cohort was obtained by searching the Radiology Information System for children referred for investigation of flatfoot. All patients with flatfoot on weight-bearing radiographs who had undergone MRI were included. Radiographs were classified by a consultant musculoskeletal radiologist as showing no underlying abnormality, talo-calcaneal coalition, calcaneonavicular coalition, accessory navicular or other abnormality. MRI studies were classified similarly by a different consultant musculoskeletal radiologist blinded to the radiographic findings. RESULTS 33 males and 24 females were included (mean age 12.5 years; range 3-18 years). 24 had bilateral abnormality, so 81 feet were assessed. Radiographs showed no specific abnormality (n = 51), talocalcaneal coalition (n = 6), calcaneonavicular coalition (n = 3), os naviculare (n = 12) or other abnormality (n = 9). MRI showed no specific abnormality (n = 40), talocalcaneal coalition (n = 10), calcaneonavicular coalition (n = 5), os naviculare (n = 12) or other abnormality (n = 14). Assuming MRI as the diagnostic gold-standard, additional relevant diagnostic information was identified in 19 (23.5%) cases, while in the 51 cases for which radiographs provided no specific diagnosis MRI confirmed no underlying abnormality in 31 (60.8%). CONCLUSION MRI is a valuable adjunct to weight-bearing radiography for investigating paediatric flatfoot deformity. ADVANCES IN KNOWLEDGE MRI is of value in the assessment of paediatric flatfoot, additional diagnostic information to radiography being identified in 23.5% cases, while in 60.8% of cases for which radiographs provided no specific diagnosis MRI confirmed no underlying abnormality.
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Affiliation(s)
- Caroline Bagley
- Department of Orthopaedic Surgery, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, UK
| | - Sean McIlhone
- TRG Imaging, North Shore City, Auckland 0620, Milford, New Zealand
| | - Nehal Singla
- Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, UK
| | - Rupert Berkeley
- Department of Radiology, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, UK
| | - Paul O’Donnell
- Department of Radiology, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, UK
| | - Sally Tennant
- Department of Orthopaedic Surgery, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, UK
| | - Asif Saifuddin
- Department of Radiology, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, UK
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8
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Golshteyn G, Schneider HP. Tarsal Coalitions. Clin Podiatr Med Surg 2022; 39:129-142. [PMID: 34809791 DOI: 10.1016/j.cpm.2021.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Tarsal coalitions are recognized as a congenital anomaly whereby the two or more bones of the hindfoot and midfoot are fused resulting in limitation of foot motion and pain. Tarsal coalitions were found to be the cause of painful flatfeet in adolescents and young adults. Developing a clinical understanding of tarsal coalitions as well as developing a step-wise conservative and surgical approach for their treatment can alleviate patient symptomatology and provide excellent long-term benefits. Conservative treatment consists of immobilization, NSAIDs, and casting for symptomatic patients, and surgical treatment for symptomatic tarsal coalition consists of resection and/or arthrodesis.
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Affiliation(s)
- Gan Golshteyn
- The Pediatric Orthopedic Center, Cedar Knolls, NJ, USA.
| | - Harry P Schneider
- Department of Surgery, Cambridge Health Alliance, Harvard Medical School, 1493 Cambridge Street, Cambridge, MA 02139, USA
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Saraiva D, Knupp M, Rodrigues AS, Gomes TM, Oliva XM. Outcomes of Posterior Arthroscopic Subtalar Arthrodesis for Medial Facet Talocalcaneal Coalition. Foot Ankle Int 2021; 42:1547-1553. [PMID: 34192978 DOI: 10.1177/10711007211027289] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Medial facet talocalcaneal coalition can be a painful condition. This study aimed to determine clinical and radiographic outcomes of posterior arthroscopic subtalar arthrodesis (PASTA) for adult patients presenting with symptomatic medial facet talocalcaneal coalition and normal hindfoot alignment, with a minimal follow-up of 18 months. METHODS Between June 2017 and July 2019, this procedure was performed on 8 feet (8 patients; mean age, 55 [42-70] years; mean BMI, 29.8 [24.4-45.0] kg/m2). Clinical assessment was performed using Visual Analog Scale for Pain (VAS-P), Foot and Ankle Outcome Score (FAOS) and the 36-Item Short-Form Health Survey (SF-36). Patient satisfaction was assessed at the last available follow-up as "very satisfied", "satisfied" or "unsatisfied". Radiographic analysis was performed using plain radiography, computed tomography (CT) scan and magnetic resonance imaging (MRI). The primary outcome was to determine both clinical and radiographic outcomes. RESULTS The mean follow-up was 25.1 (18.2-34.2) months. The authors found statistically significant improvement on all clinical scores (VASP-P, FAOS and SF-36). They registered 6 "very satisfied" patients, 2 "satisfied" patients and no "unsatisfied" patient. Fusion of the subtalar joint was observed in all patients by 12 weeks and in 5 of them as soon as 8 weeks postoperatively (mean, 9.5 [8-12] weeks). There were no cases of delayed fusion or nonunion of the subtalar joint, superficial or deep infection, neurovascular damage, thromboembolic event, screw breakage, need for hardware removal or revision surgery. CONCLUSION This study found that PASTA is a safe and reliable technique for adult patients presenting with symptomatic medial facet talocalcaneal coalition and normal hindfoot alignment, demonstrating and maintaining clinical improvement at an average follow-up of 2 years. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Daniel Saraiva
- Hospital da Prelada, Porto, Portugal.,Foot and Ankle Unit, Department of Anatomy and Human Embryology, Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Markus Knupp
- Mein Fusszentrum, Basel, Switzerland4Faculty of Medicine, University of Basel, Basel, Switzerland.,Faculty of Medicine, University of Basel, Basel, Switzerland
| | | | - Tiago Mota Gomes
- Foot and Ankle Unit, Department of Anatomy and Human Embryology, Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Xavier Martin Oliva
- Foot and Ankle Unit, Department of Anatomy and Human Embryology, Faculty of Medicine, University of Barcelona, Barcelona, Spain
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Surgical Treatment of Calcaneonavicular and Talocalcaneal Coalitions. Foot Ankle Clin 2021; 26:873-901. [PMID: 34752242 DOI: 10.1016/j.fcl.2021.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Tarsal coalition is determined by an absence of segmentation between one or more foot bones. The main symptom is activity-related foot pain, usually dorsolateral for calcaneonavicular coalitions and medial for talocalcaneal ones. At presentation, a symptomatic tarsal coalition must be treated conservatively for at least 6 months. If the conservative treatment fails and the foot is still painful, resection is the treatment of choice. Advantage of surgery is to restore mobility and reduce the risk of subsequent degenerative arthritis. Common pitfalls of surgery include failure to recognize associated coalitions, inadequate or extensive resection, and injury of adjoining bones.
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11
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Berkeley R, Tennant S, Saifuddin A. Multimodality imaging of the paediatric flatfoot. Skeletal Radiol 2021; 50:2133-2149. [PMID: 34002241 DOI: 10.1007/s00256-021-03806-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 04/29/2021] [Accepted: 04/29/2021] [Indexed: 02/02/2023]
Abstract
Flatfoot is commonly encountered in the paediatric population and describes a spectrum of clinical and radiological presentations which encompass both normally developing and pathological feet. Flatfoot can be categorised as flexible or rigid, a distinction which has important implications when considering the potential underlying aetiology and treatment options, and therefore imaging is an important component of the diagnostic workup. Weight-bearing plain radiographs are established initial investigations, although the significance of a number of the commonly derived quantitative parameters in children remains unclear. CT and MRI are important additional imaging modalities reserved for the investigation of symptomatic cases or those in which an underlying structural abnormality is suspected, rigid flatfoot commonly falling into one of these two categories. We review and illustrate the multimodality imaging of the paediatric flatfoot, with reference to both qualitative and quantitative radiographic assessment and cross-sectional imaging appearances.
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Affiliation(s)
- Rupert Berkeley
- Department of Radiology, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP, Middlesex, UK.
| | - Sally Tennant
- Department of Orthopaedic Surgery, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP, Middlesex, UK
| | - Asif Saifuddin
- Department of Radiology, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP, Middlesex, UK
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Emara KM, Diab RA, Amr M, Mahmoud SA, Nour M, Abdelsalam A, Elshobaky MA, Farhan M, Gemeah M, Emara AK. Virtual orthopedic assessment: Main principles and specific regions. World J Orthop 2021; 12:672-684. [PMID: 34631451 PMCID: PMC8472440 DOI: 10.5312/wjo.v12.i9.672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 05/07/2021] [Accepted: 08/06/2021] [Indexed: 02/06/2023] Open
Abstract
Telemedicine was originally created as a way to treat patients who were located in remote places far away from local health facilities or in areas with shortages of medical professionals. Telemedicine is still used today to address those problems, and is increasingly becoming a tool for convenient medical care. With the emergence of pandemics, telemedicine became almost a mandatory and valuable option for continuing to provide medical care in various specialties. As the threat of pandemic progress has continued for months and may continue for years, it is essential to validate existing tools to maintain clinical assessment and patient treatment to avoid negative consequences of the lack of medical follow-up. Therefore, the establishment of a virtual assessment technique that can be conducted effectively is of outmost importance as a way of adapting to the current situation. This study evaluated the role of telemedicine in the assessment of various orthopedic pathologies by means of a systematic virtual evaluation.
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Affiliation(s)
- Khaled M Emara
- Orthopedic Surgery Department, Ain Shams University, Cairo 11566, Egypt
| | - Ramy Ahmed Diab
- Orthopedic Surgery Department, Ain Shams University, Cairo 11566, Egypt
| | - Mohamed Amr
- Orthopedic Surgery Department, Ain Shams University, Cairo 11566, Egypt
| | | | - Mohamed Nour
- Orthopedic Surgery Department, Bank Ahly Hospital, Cairo 11566, Egypt
| | - Ahmed Abdelsalam
- Orthopedic Surgery Department, Ain Shams University, Cairo 11566, Egypt
| | | | - Mona Farhan
- Orthopedic Surgery Department, Ain Shams University, Cairo 11566, Egypt
| | - Mostafa Gemeah
- Department of Health Care Innovation, Arizona State University, Arizona, AZ 85287, United States
| | - Ahmed K Emara
- Department of Orthopedic Surgery, Cleveland Clinic, Ohio, NY 44195, United States
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Wang A, Shi W, Gao L, Chen L, Xie X, Zhao F, Pi Y, Jiao C, Hu Y, Jiang D, Guo Q. A new classification of talocalcaneal coalitions based on computed tomography for operative planning. BMC Musculoskelet Disord 2021; 22:678. [PMID: 34380445 PMCID: PMC8356385 DOI: 10.1186/s12891-021-04567-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 08/02/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Current classifications emphasize the morphology of the coalition, however, subtalar joint facets involved should also be emphasized. OBJECTIVE The objective of this study was to develop a new classification system based on the articular facets involved to cover all coalitions and guide operative planning. METHODS Patients were diagnosed with talocalcaneal coalition using a CT scan, between January 2009 and February 2021. The coalition was classified into four main types according to the shape and nature of the coalition: I, inferiorly overgrown talus or superiorly overgrown calcaneus; II, both talus and calcaneus overgrew; III, coalition with an accessory ossicle; IV, complete osseous coalition (I-III types are non-osseous coalition). Then each type was further divided into three subtypes according to the articular facets involved. A, the coalition involving the anterior facets; M, the coalition involving the middle facets, and P, the coalition involving the posterior facets. Interobserver reliability was measured at the main type (based on nature and shape) and subtype (articular facet involved) using weighted Kappa. Results There were 106 patients (108 ft) included in this study. Overall, 8 ft (7.5%) were classified as type I, 75 ft (69.4%) as type II, 7 ft (6.5%) as type III, and 18 ft (16.7%) as type IV. Twenty-nine coalitions (26.9%) involved the posterior facets only (subtype-P), 74 coalitions (68.5%) involved both the middle and posterior facets (subtype-MP), and five coalitions (4.6%) simultaneously involved the anterior, middle, and posterior facets (subtype-AMP). Type II-MP coalition was the most common. The value of weighted Kappa for the main type was 0.93 (95%CI 0.86-0.99) (p<0.001), and the value for the subtype was 0.78 (95%CI 0.66-0.91) (p<0.001). CONCLUSION A new classification system of the talocalcaneal coalition to facilitate operative planning was developed.
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Affiliation(s)
- Anhong Wang
- Department of Sports Medicine, Peking University Third Hospital. Institute of Sports Medicine of Peking University. Beijing Key Laboratory of Sports Injuries, 49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Weili Shi
- Department of Sports Medicine, Peking University Third Hospital. Institute of Sports Medicine of Peking University. Beijing Key Laboratory of Sports Injuries, 49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Lixiang Gao
- Department of Radiology, Peking University Third Hospital, Beijing, China
| | - Linxin Chen
- Department of Sports Medicine, Peking University Third Hospital. Institute of Sports Medicine of Peking University. Beijing Key Laboratory of Sports Injuries, 49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Xing Xie
- Department of Sports Medicine, Peking University Third Hospital. Institute of Sports Medicine of Peking University. Beijing Key Laboratory of Sports Injuries, 49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Feng Zhao
- Department of Sports Medicine, Peking University Third Hospital. Institute of Sports Medicine of Peking University. Beijing Key Laboratory of Sports Injuries, 49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Yanbin Pi
- Department of Sports Medicine, Peking University Third Hospital. Institute of Sports Medicine of Peking University. Beijing Key Laboratory of Sports Injuries, 49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Chen Jiao
- Department of Sports Medicine, Peking University Third Hospital. Institute of Sports Medicine of Peking University. Beijing Key Laboratory of Sports Injuries, 49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Yuelin Hu
- Department of Sports Medicine, Peking University Third Hospital. Institute of Sports Medicine of Peking University. Beijing Key Laboratory of Sports Injuries, 49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Dong Jiang
- Department of Sports Medicine, Peking University Third Hospital. Institute of Sports Medicine of Peking University. Beijing Key Laboratory of Sports Injuries, 49 North Garden Road, Haidian District, Beijing, 100191, China.
| | - Qinwei Guo
- Department of Sports Medicine, Peking University Third Hospital. Institute of Sports Medicine of Peking University. Beijing Key Laboratory of Sports Injuries, 49 North Garden Road, Haidian District, Beijing, 100191, China.
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Malik-Tabassum K, Wahed K, To C, Maling L, Rose B. Post-operative outcomes of arthroscopic tarsal coalition resection: A systematic review. J Orthop 2020; 21:537-543. [PMID: 33029041 DOI: 10.1016/j.jor.2020.09.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 09/21/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Arthroscopic resection of tarsal coalitions is a relatively new technique. This systematic review aimed to investigate the post-operative complications and functional outcomes in arthroscopic resection of tarsal coalitions. METHODS PubMed, Medline, Embase and Cochrane library were searched for studies that reported outcomes in arthroscopic resection of tarsal coalitions. RESULTS 8 studies met the inclusion criteria. Post-operative outcomes were reported in 103 cases. The overall complication rate was 13.6%. Tibial nerve injury was reported in 1 patient. All included studies demonstrated post-operative improvement in functional outcomes. CONCLUSION Arthroscopic resection is a feasible and effective treatment method for symptomatic tarsal coalitions.
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Affiliation(s)
- Khalid Malik-Tabassum
- Specialty Registrar, Trauma & Orthopaedics, Conquest Hospital, East Sussex Healthcare NHS Trust, Hastings, United Kingdom
| | - Karim Wahed
- Specialty Registrar, Trauma & Orthopaedics, Eastbourne District General Hospital, East Sussex Healthcare NHS Trust, Eastbourne, United Kingdom
| | - Christopher To
- Specialty Registrar, Trauma & Orthopaedics, Conquest Hospital, East Sussex Healthcare NHS Trust, Hastings, United Kingdom
| | - Lucy Maling
- Specialty Registrar, Trauma & Orthopaedics, Conquest Hospital, East Sussex Healthcare NHS Trust, Hastings, United Kingdom
| | - Barry Rose
- Consultant Trauma & Orthopaedic Surgeon, Eastbourne District General Hospital, East Sussex Healthcare NHS Trust, Eastbourne, United Kingdom
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Di Gennaro GL, Stallone S, Olivotto E, Zarantonello P, Magnani M, Tavernini T, Stilli S, Trisolino G. Operative versus nonoperative treatment in children with painful rigid flatfoot and talocalcaneal coalition. BMC Musculoskelet Disord 2020; 21:185. [PMID: 32209079 PMCID: PMC7093982 DOI: 10.1186/s12891-020-03213-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 03/13/2020] [Indexed: 11/23/2022] Open
Abstract
Background The management of painful rigid flatfoot (RFF) with talocalcaneal coalition (TCC) is controversial. We aimed to compare operative and nonoperative treatment in children with RFF and TCC. Methods We retrospectively reviewed medical records and radiographs of children with RFF and TTC treated between 2005 and 2015. The nonoperative treatment consisted of manipulation under anesthesia, cast immobilization and shoe insert after cast removal. The operative treatment consisted of combined TCC resection, graft interposition and subtalar arthroereisis. Results Thirty-four children (47 ft) in the nonoperative group and twenty-one children (34 ft) in the operative group were included. No differences were found between groups, concerning baseline characteristics. The mean age at treatment was 11.8 years (9–17): 11.6 (9–17) for the nonoperative group, 12.2 (10–15) for the operative group. The mean follow-up averaged 6.6 (3–12) years and was significantly longer in the nonoperative group (7.8 versus 4.7 years; p < 0.0005), since the operative procedure was increasingly practiced in the latest years. There were no complications in either groups, but 6 patients (7 ft) in the nonoperative group were unsatisfied and required surgery. At the latest follow-up, the AOFAS-AHS improved in both groups, although the operative group showed significantly better improvement. The operative group reported also significantly better FADI score, after adjustment for follow-up and baseline variables. Conclusion The operative treatment showed better results compared to the nonoperative treatment. Symptomatic RFF with TCC in children can be effectively treated in one step with resection, graft interposition and subtalar arthroereisis. Further prospective randomized studies are needed to confirm our findings and to identify the best operative strategy in this condition.
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Affiliation(s)
| | - Stefano Stallone
- Pediatric Orthopedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Eleonora Olivotto
- RAMSES Laboratory, RIT Department, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Paola Zarantonello
- Pediatric Orthopedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Marina Magnani
- Pediatric Orthopedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Tullia Tavernini
- Pediatric Orthopedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Stefano Stilli
- Pediatric Orthopedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Giovanni Trisolino
- Pediatric Orthopedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
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Abstract
PURPOSE OF REVIEW Tarsal coalitions may cause painful pes planovalgus and recurrent sprains, and can lead to arthrosis if improperly managed. In this review, we discuss the current topics related to talocalcaneal and calcaneonavicular coalitions. RECENT FINDINGS Tarsal coalitions are initially managed with conservative therapy, and when this approach fails, surgery is performed. Treatment of calcaneonavicular coalitions involves resection of the coalition and interposition of the extensor digitorum brevis muscle or fat, and in cases of marked valgus deformity, correction of the deformity. In talocalcaneal coalitions, recommendations include coalition resection for those affecting less than 50% of the area of the posterior facet and with a less than 16° valgus, coalition resection and valgus correction for those affecting less than 50% of the area and valgus greater than 16°, and isolated valgus correction for those affecting more than 50% of the area and with a more than or less than 16° valgus. Arthrodesis is reserved as a salvage procedure. SUMMARY Talocalcaneal and calcaneonavicular coalitions can cause painful pes planovalgus. Their diagnoses are confirmed by plain radiograph, computed tomography, and, in cases of fibrous or cartilaginous coalitions, MRI. Initial treatment is conservative, and when symptoms persist, resection of the coalition is recommended along with tissue graft interposition with or without associated valgus correction. Arthrodesis is indicated as a salvage procedure whenever treatment fails or with advanced arthrosis.
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The natural course of pain in patients with symptomatic tarsal coalitions: A retrospective clinical study. Foot Ankle Surg 2020; 26:228-232. [PMID: 30926227 DOI: 10.1016/j.fas.2019.03.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Revised: 01/30/2019] [Accepted: 03/05/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND This study aims to examine changes in pain intensity in the long course of symptomatic tarsal coalition. METHODS Thirty consecutive patients who were treated for symptomatic tarsal coalition was retrospectively reviewed. The patients were divided into two groups: the nonsurgical group (14 patients) and the surgical group (16 patients). To assess pain intensity, the visual analogous scale (VAS) was utilized. RESULTS On admission, the mean VAS was 4,9 ± 1,9 in the nonsurgical group and 7,7 ± 1,3 in the surgical group (p < 0,05). After 6 months of nonoperative treatment, the mean VAS was decreased from 4,9 ± 1,9 to 2,8 ± 1,0 in the nonsurgical group (p < 0,05) and from 7,7 ± 1,3 to 7,1 ± 0,8 in the surgical group (p > 0,05). At the final follow-up, the mean VAS was 2,3 ± 2,4 in the nonsurgical group and 3,1 ± 2,7 in the surgical group (p > 0,05). The decrease in the VAS after surgery was significant in the surgical group (p < 0,01). CONCLUSION For patients with symptomatic tarsal coalitions who present with an initial VAS score of 6 and above, early surgery may be more effective than nonoperative treatment in relieving pain intensity.
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Analysis of three-dimensional computed tomography talar morphology in relation to pediatric pes planovalgus deformity. J Pediatr Orthop B 2019; 28:591-597. [PMID: 31584923 DOI: 10.1097/bpb.0000000000000597] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Intraosseous alignment of the tarsal bone has not been investigated in relation to various foot deformities. This study aimed to investigate three-dimensional computed tomography (3D CT) talar morphology in children with idiopathic and neuromuscular pes planovalgus. Eleven children [nine boys, two girls; mean (SD) age: 10.5 (2.8) years] with idiopathic pes planovalgus and 15 children [three boys, 12 girls; mean (SD) age: 10.8 (3.4) years] with neuromuscular pes planovalgus were included. All patients underwent 3D CT and weight-bearing anteroposterior, lateral, and axial radiography. Demographic data and talar 3D CT and radiographic measurements were compared between both groups. The correlation between the measurements was also analyzed. The neuromuscular group showed significantly more severe deformity than the idiopathic group in the radiographic and 3D sagittal talus measurements. The 3D coronal talus measurement showed a significant negative correlation with the axial hindfoot alignment in the idiopathic group while the 3D transverse talus measurement was significantly correlated with the lateral talocalcaneal angle in the neuromuscular group. 3D intraosseous alignment of the talus is correlated with pes planus deformity. Longitudinal and biomechanical studies including a control group are necessary to elucidate the role of 3D talar morphology on a dynamic imbalance in pes planovalgus.
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Putz C, Hagmann S, Dreher T. [Imaging diagnostics of the foot : What the orthopaedic surgeon expects from the radiologist]. Radiologe 2019; 58:400-405. [PMID: 29318349 DOI: 10.1007/s00117-017-0347-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
CLINICAL/METHODICAL ISSUE Foot pain is in the case of long-term congenital, acquired or posttraumatic foot deformities a relevant clinical problem. STANDARD RADIOLOGICAL METHODS On the basis of the clinical findings and the orthopaedic question, radiographs of the foot while standing in two planes are supplemented by radiographs of the ankle in an anterior-posterior plane. The imaging diagnostics of the foot are based on the conventional X‑ray diagnostic workup and becomes even more precise and differentiated by the possibility of intersecting imaging procedures. PERFORMANCE The diagnostic significance of imaging methods is discussed in this overview by means of clinical examples. In this context, cross-sectional imaging procedures can serve the clinician in the further decision-making process and clarify the question whether surgical treatment, for example, in the case osteoarthrosis is indicated. PRACTICAL RECOMMENDATIONS Primarily, prior to any imaging procedure the appropriate medical history, inspection, clinical examination and the gait analysis in patients with foot pain are necessary. Interdisciplinary communication between orthopaedic/trauma surgeons and radiologists is necessary in order to provide the right imaging modality for difficult questions, to correctly interpret the resulting imaging findings, and to derive a therapeutic consequence from this. The decision whether conservative therapy or a surgical procedure is recommended will be made depending on the patients' prior therapies and the restriction of quality of life.
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Affiliation(s)
- C Putz
- Abteilung Kinderorthopädie, Neuroorthopädie und Fußchirurgie, Zentrum für Orthopädie und Unfallchirurgie, Orthopädische Universitätsklinik Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland.
| | - S Hagmann
- Abteilung Kinderorthopädie, Neuroorthopädie und Fußchirurgie, Zentrum für Orthopädie und Unfallchirurgie, Orthopädische Universitätsklinik Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland
| | - T Dreher
- Abteilung Kinderorthopädie, Neuroorthopädie und Fußchirurgie, Zentrum für Orthopädie und Unfallchirurgie, Orthopädische Universitätsklinik Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland
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So E, Renner K, Quisno A, Logan D. The Rare Lateral Cuneocuboid Coalition: A Case Report. J Am Podiatr Med Assoc 2019; 109:231-234. [PMID: 29130734 DOI: 10.7547/17-018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Tarsal coalitions typically occur at the talocalcaneal or calcaneonavicular joints. Common findings are pain, limited range of motion, and a pes planus deformity. The focus of this case report includes the presentation, imaging, treatment, and outcomes for a 21-year-old woman diagnosed with a rare lateral cuneocuboid coalition with chronic pain. Clinical and radiographic examinations, typically used to diagnose the common coalition, were unremarkable. Magnetic resonance imaging was diagnostic of the lateral cuneocuboid coalition, which was successfully treated with surgical resection. At 6-year follow-up, she reports resolution of symptoms and has returned to her normal presurgical activity level pain-free. This case is only the third lateral cuneocuboid coalition reported in the literature. The rarity of this coalition and its nonsuspicious clinical presentation make it worthy of acknowledgment.
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Affiliation(s)
- Eric So
- Grant Medical Center, Columbus, OH
| | | | - Amanda Quisno
- Grant Medical Center, Columbus, OH
- Private practice, Columbus, OH
| | - Daniel Logan
- Grant Medical Center, Columbus, OH
- Private practice, Columbus, OH
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Cho BK, Park JK. Realignment Calcaneal Osteotomy for Bilateral Complete Talocalcaneal Synostosis: A Case Report. J Foot Ankle Surg 2019; 58:599-603. [PMID: 30914151 DOI: 10.1053/j.jfas.2018.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Indexed: 02/03/2023]
Abstract
Talocalcaneal synostosis is a congenital failure of the segmentation between tarsal bones. It may be very difficult to differentiate from talocalcaneal coalition, known as the most common tarsal coalition, especially in cases with a large bone bridge. Complete talocalcaneal synostosis is very rare, and there are few references in the literature about the clinical outcomes and operative methods for symptomatic synostosis. We report a case of a 15-year-old female with bilateral complete talocalcaneal synostosis and heel varus deformity who has experienced good clinical results after lateral sliding calcaneal osteotomy for hindfoot realignment.
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Affiliation(s)
- Byung-Ki Cho
- Professor, Department of Orthopaedic Surgery, College of Medicine, Chungbuk National University, Cheongju, Korea.
| | - Ji-Kang Park
- Professor, Department of Orthopaedic Surgery, College of Medicine, Chungbuk National University, Cheongju, Korea
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Duan X, Yang L. Treatment of isolated talonavicular coalition: Case report and literature review. J Int Med Res 2018; 46:5322-5330. [PMID: 30453800 PMCID: PMC6300927 DOI: 10.1177/0300060518810889] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 10/09/2018] [Indexed: 11/16/2022] Open
Abstract
Tarsal coalition refers to an abnormal fibrous, cartilaginous, or bony connection that develops between two or more tarsal bones. Talocalcaneal coalition and calcaneonavicular coalition account for more than 90% of all cases of tarsal coalition. Coalition exists early at birth, but bony connection usually develops during the patient's late growth period. Isolated cases of talonavicular coalition have rarely been reported. We herein report a case involving an 11-year-old patient with an isolated talonavicular coalition from a soft tissue to bony connection who was treated with arthroscopy for ankle arthritis. To our knowledge, this is the first case in which the whole formation of the talonavicular coalition was observed with a series of radiographic and magnetic resonance imaging examinations. The pain caused by the talonavicular coalition was managed by nonoperative treatment, while the ankle pain caused by the arthritis was relieved after ankle arthroscopy. At 6 years postoperatively, the patient remained pain-free while walking for 30 minutes and was satisfied with the operative outcome. Continuous follow-up confirmed that after the formation of talonavicular coalition, the coalition can continue to progress, forming bony talocalcaneal coalition and calcaneocuboid coalition.
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Affiliation(s)
- Xiaojun Duan
- Center for Joint Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, P. R. China
| | - Liu Yang
- Center for Joint Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, P. R. China
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23
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Abstract
Tarsal coalitions are the result of impaired mesenchymal separation of the tarsal bones. The most common types include calcaneonavicular or talocalcaneal coalitions. Subtalar stiffness results in pathologic kinematics with increased risk of ankle sprains, planovalgus foot deformity, and progressive joint degeneration. Resection of the coalition yields good results. Tissue interposition may reduce the risk of reossification, and concomitant deformity should be addressed in the same surgical setting.
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Affiliation(s)
- Georg Klammer
- Foot and Ankle Surgery, FussInstitut Zurich, Kappelistrasse 7, Zurich 8002, Switzerland.
| | - Norman Espinosa
- Foot and Ankle Surgery, FussInstitut Zurich, Kappelistrasse 7, Zurich 8002, Switzerland
| | - Lukas Daniel Iselin
- Foot and Ankle Surgery, Department of Orthopaedic Surgery and Traumatology, Spitalstrasse 16, Kantonsspital Lucerne, Lucerne 6000, Switzerland
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Aldahshan W, Hamed A, Elsherief F, Abdelaziz AM. Endoscopic Resection of Different Types of Talocalcaneal Coalition. Foot Ankle Int 2018; 39:1082-1088. [PMID: 29661082 DOI: 10.1177/1071100718770625] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to describe the technique of endoscopic resection of talocalcaneal coalition (TCC) by using 2 posterior portals and to report the outcomes of endoscopic resection of different types and sites of TCC. METHODS An interventional prospective study was conducted on 20 feet in 18 consecutive patients who were diagnosed by computed tomography to have TCC for which nonoperative treatment had failed and endoscopic resection was performed. The patients were divided into groups according to the site of the coalition (middle facet or posterior facet) and according to type (fibrous, cartilage, or bony). The mean follow-up period was 26 months (range, 6-36). RESULTS The average preoperative American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score was 57.7 (range, 40-65), and the average preoperative visual analog scale (VAS) score was 7.8 (range, 6-8). The average postoperative AOFAS hindfoot score was 92.4 (range, 85-98; P < .01). The average postoperative VAS score was 2.4 (range, 1-4). All patients showed no recurrence on postoperative lateral and Harris-Beath X-ray until the end of the study. CONCLUSIONS Endoscopic resection of TCC was an effective and useful method for the treatment of talocalcaneal coalition. It provided excellent outcomes with no recurrence in this short-term study. Resection of the fibrous type had a better outcome than resection of cartilage and bony types. Endoscopic resection of the posterior coalition had a better outcome than resection of the middle coalition. LEVEL OF EVIDENCE Level III, comparative study.
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Affiliation(s)
- Wael Aldahshan
- 1 Alzahraa University Hospital, Faculty of Medicine for Girls, Al-azhar University, Cairo, Egypt
| | - Adel Hamed
- 1 Alzahraa University Hospital, Faculty of Medicine for Girls, Al-azhar University, Cairo, Egypt
| | - Faisal Elsherief
- 1 Alzahraa University Hospital, Faculty of Medicine for Girls, Al-azhar University, Cairo, Egypt
| | - Ashraf Mohamed Abdelaziz
- 1 Alzahraa University Hospital, Faculty of Medicine for Girls, Al-azhar University, Cairo, Egypt
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Hubert J, Hawellek T, Beil FT, Saul D, Kling JH, Viebahn C, Jungesblut O, Stücker R, Rupprecht M. Resection of Medial Talocalcaneal Coalition With Interposition of a Pediculated Flap of Tibialis Posterior Tendon Sheath. Foot Ankle Int 2018; 39:935-941. [PMID: 29682982 DOI: 10.1177/1071100718768257] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of the study was to present a novel operative technique in the management of medial talocalcaneal coalition (TC) and to report our clinical and radiologic results after interposition of a pediculated flap (PF) of the tibialis posterior tendon sheath. METHODS Twelve feet of 10 patients with a medial TC were treated with the interposition of PF of the tibialis posterior tendon sheath following resection. Pre- and postoperative clinical examinations were performed to evaluate the range of motion and the function of the tibialis posterior muscle of the affected foot. Pain was registered by visual analog scale (VAS) and the function of the foot by the American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score. The mean follow-up duration was 57.2 months (SD ±37.2 range 12-128) after surgery. Magnetic resonance imaging (MRI) was carried out to assess the outcome. RESULTS All patients reported a significant reduction of pain ( P = .002) at the final follow-up. The activity level had improved since the operation, and the subtalar joint motion was increased, but no weakness of the tibialis posterior muscle could be observed. The AOFAS hindfoot score was significantly improved ( P = .002). MRI did not reveal any migration of the tibialis posterior tendon sheath, and the interposed PF was confirmed at the resection zone. Furthermore, no TC relapse or ruptures of the functional anatomical structures could be observed. CONCLUSION The resection combined with the interposition of a PF of the tendon sheath seems to avoid relapse of TC and improves symptoms and the function of the foot. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Jan Hubert
- 1 Department of Trauma, Orthopaedics and Plastic Surgery, University Medical Center Göttingen, Göttingen, Germany
| | - Thelonius Hawellek
- 1 Department of Trauma, Orthopaedics and Plastic Surgery, University Medical Center Göttingen, Göttingen, Germany
| | - Frank Timo Beil
- 1 Department of Trauma, Orthopaedics and Plastic Surgery, University Medical Center Göttingen, Göttingen, Germany
| | - Dominik Saul
- 1 Department of Trauma, Orthopaedics and Plastic Surgery, University Medical Center Göttingen, Göttingen, Germany
| | - Jens Henning Kling
- 1 Department of Trauma, Orthopaedics and Plastic Surgery, University Medical Center Göttingen, Göttingen, Germany
| | - Christoph Viebahn
- 2 Institute of Anatomy and Embryology, University Medical Center Goettingen, Göttingen, Germany
| | - Oliver Jungesblut
- 3 Department of Orthopaedics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ralf Stücker
- 3 Department of Orthopaedics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,4 Department of Pediatric Orthopaedics, Altonaer Children's Hospital, Hamburg, Germany
| | - Martin Rupprecht
- 3 Department of Orthopaedics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,4 Department of Pediatric Orthopaedics, Altonaer Children's Hospital, Hamburg, Germany
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Relationship between Subtalar Joint Stiffness and Relaxed Calcaneal Stance Position in Cerebral Palsy Children with Valgus Deformities. BIOMED RESEARCH INTERNATIONAL 2018; 2018:6576108. [PMID: 29854778 PMCID: PMC5952502 DOI: 10.1155/2018/6576108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 02/27/2018] [Accepted: 03/21/2018] [Indexed: 11/18/2022]
Abstract
Relaxed calcaneal stance position (RCSP) is an important index in the correctional treatment of foot valgus deformities for cerebral palsy (CP) children. However, patients with similar RCSP showed diverse outcomes when accepting similar treatment, as the corrective resistance of subtalar joint (STJ) could be quite different. This study aimed to investigate the relationship between STJ stiffness and RCSP in different loading conditions. 38 valgus feet of 19 CP subjects were included in the study. A reposition force was applied beneath the STJ and pushed the foot from pronated position to neutral position. The STJ stiffness was calculated as the slope of the line fitting the force-displacement data. Correlations between the STJ stiffness, RCSP, and composite spasticity index (CSI) were analyzed. The spearman correlation coefficient indicated that STJ stiffness had no correlation with RCSPs, yet it had negative correlation with the change of RCSP under difference loading conditions (ΔRCSP1w−0w and ΔRCSP0.5w−0w). STJ stiffness was also correlated with the composite spasticity index (CSI), implying that this index had an advantage in reflecting the mechanism of valgus deformity and should be considered as a necessary measurement of foot valgus in CP children. The present method for quantification of STJ stiffness could improve the accuracy in the diagnosis and classification of foot deformity and may help increase the understanding of the biomechanical factors in foot deformity rehabilitation.
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Abstract
PURPOSE It has been the observation of the senior author that there is a bony fullness or "double medial malleolus" over the middle facet as a consistent finding with most talocalcaneal coalitions (TCC). To document this observation, we reviewed records and radiographs in 3 patient groups. METHODS Part 1: retrospective chart review was completed for 111 feet to determine the clinical presence of a palpable "double medial malleolus." Part 2: computed tomography (CT) scans for evaluation of tarsal coalition or symptomatic flatfoot between January 2006 and December 2014 were retrospectively reviewed for the same cohort. Soft tissue thickness was measured as the shortest distance between bone and skin surface at both the medial malleolus and the middle facet/coalition. The volume of the middle facet or coalition was measured at their midpoint. These findings were compared among feet with TCC (n=53), calcaneonavicular coalition (CNC) (n=20), and flatfoot (n=38). RESULTS Part 1-clinical: from medical records, 38 feet (34%) had documented record of a palpable medial prominence. Of the feet reviewed with a "double medial malleolus," all had TCC (no false positives or false negatives). Clinical and CT prominence demonstrated significant correlation (rs=0.519, P=0.001). Part 2-radiographic: CT observation of "double medial malleolus" is significantly associated with TCC (P<0.001). CT observation of double medial malleolus is 81% sensitive and 79% specific as a predictive test for TCC. The middle facet-to-skin distance was significantly closer in those with TCC versus controls (P<0.001). The ratio was larger in patients with TCC versus CNC (P=0.006) or flatfeet (P<0.001). Volume was nearly twice the size in patients with TCC versus the controls (P<0.001). CONCLUSIONS TCCs have a bony prominence below the medial malleolus on clinical exam and CT scan not present in flatfeet or CNCs. This abnormal middle facet is almost twice the size of the normal middle facet. Obesity or severe valgus may mask this finding. If a palpable bony prominence is noted just below the medial malleolus during examination of a painful foot with a decrease in subtalar motion, the likely diagnosis is TCC. With this added clinical finding, appropriate images can be ordered to confirm the diagnosis of the latter. We advise CT scans with 3D images for surgical planning. The primary finding for tarsal coalitions in textbooks is decreased subtalar motion. This new finding of a palpable enlarged medial prominence just below the medial malleolus is highly associated with TCCs. LEVEL OF EVIDENCE Level III.
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Ho-Fung VM, Zapala MA, Lee EY. Musculoskeletal Traumatic Injuries in Children. Radiol Clin North Am 2017; 55:785-802. [DOI: 10.1016/j.rcl.2017.02.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Winslow J, Norland R, Storb N, Cannella S, King D. Arthrodesis of the Subtalar Joint in a High School Football Player With a Talocalcaneal Coalition: Case Report With Functional Analysis. Foot Ankle Spec 2016; 9:550-554. [PMID: 26856982 DOI: 10.1177/1938640016630061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
UNLABELLED Tarsal coalition is a bony or fibrous bridge between 2 tarsal bones. The condition is typically congenital and presents in early to mid-adolescence. Common symptoms include ankle pain, stiffness, and limited range of motion. Conservative treatment of tarsal coalition consists of immobilization, short leg walking cast, steroid injections, physical therapy, ankle braces, and orthotics. When conservative care fails, surgical intervention for tarsal coalition includes excision of the coalition or joint arthrodesis. We present a case of a high school football player with a 5-year history of left ankle pain secondary to a talocalcaneal coalition. The athlete did not respond favorably to conservative treatment and underwent a subtalar joint arthrodesis. Prior to surgery, the athlete consented to self-reported functional outcome measures, range of motion measures, and 3D video gait analysis to evaluate the effects of surgery. Measurements were taken prior to surgery and 1½ years after surgery. Clinically significant improvements were seen in subjective outcome measures and functional ankle range of motion in this case. There is limited research available to validate long-term outcomes for current conservative and surgical treatments of tarsal coalition. In this case, joint arthrodesis resulted in a good long-term outcome for this athlete. LEVELS OF EVIDENCE Therapeutic, Level IV: Case study.
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Affiliation(s)
- John Winslow
- Departments of Physical Therapy (JW, RN, NS), Ithaca College, New York.,Exercise Science (SC, DK), Ithaca College, New York
| | - Ryan Norland
- Departments of Physical Therapy (JW, RN, NS), Ithaca College, New York.,Exercise Science (SC, DK), Ithaca College, New York
| | - Nathan Storb
- Departments of Physical Therapy (JW, RN, NS), Ithaca College, New York.,Exercise Science (SC, DK), Ithaca College, New York
| | - Sam Cannella
- Departments of Physical Therapy (JW, RN, NS), Ithaca College, New York.,Exercise Science (SC, DK), Ithaca College, New York
| | - Deborah King
- Departments of Physical Therapy (JW, RN, NS), Ithaca College, New York.,Exercise Science (SC, DK), Ithaca College, New York
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Bixby SD, Jarrett DY, Johnston P, Mahan ST, Kleinman PK. Posteromedial subtalar coalitions: prevalence and associated morphological alterations of the sustentaculum tali. Pediatr Radiol 2016; 46:1142-9. [PMID: 27003133 DOI: 10.1007/s00247-016-3584-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 01/19/2016] [Accepted: 02/11/2016] [Indexed: 11/24/2022]
Abstract
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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Affiliation(s)
- Sarah D Bixby
- Department of Radiology, Harvard Medical School, Boston Children's Hospital, 300 Longwood Ave., Boston, MA, 02115, USA.
| | - Delma Y Jarrett
- Department of Radiology, Harvard Medical School, Boston Children's Hospital, 300 Longwood Ave., Boston, MA, 02115, USA
| | | | - Susan T Mahan
- Department of Orthopaedic Surgery, Harvard Medical School, Boston Children's Hospital, Boston, MA, USA
| | - Paul K Kleinman
- Department of Radiology, Harvard Medical School, Boston Children's Hospital, 300 Longwood Ave., Boston, MA, 02115, USA
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Quinn EA, Peterson KS, Hyer CF. Calcaneonavicular Coalition Resection With Pes Planovalgus Reconstruction. J Foot Ankle Surg 2016; 55:578-82. [PMID: 26964697 DOI: 10.1053/j.jfas.2016.01.048] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Indexed: 02/03/2023]
Abstract
Calcaneonavicular coalitions can lead to a painful, rigid pes planovalgus deformity. Historical treatment of coalitions recommends resection. A newer concept in coalition treatment includes concomitant flatfoot reconstruction. In the present study, we hoped to demonstrate the ability to reconstruct a flatfoot deformity with concomitant calcaneonavicular coalition resection. We performed a retrospective comparative study of patients undergoing isolated calcaneonavicular bar excision (group A) with those undergoing calcaneonavicular bar excision and concomitant pes planovalgus reconstruction (group B). The radiographic parameters of pes planovalgus correction were measured on the pre- and postoperative radiographs, including talar head uncoverage, calcaneal inclination, and anteroposterior and lateral talo-first metatarsal angle. Calcaneonavicular coalition resection was performed using a standard technique with or without biologic spacers. Associated flatfoot reconstruction included posterior muscle group lengthening, calcaneal osteotomy, and/or midfoot osteotomy. Of the 27 patients, 20 were included in group A and 7 in group B. Their mean age was 18.1 years. Improvement was seen in the radiographic parameters for patients undergoing calcaneonavicular bar excision with concomitant flatfoot procedures, with statistical significance found in the calcaneal inclination (p = .013). Talar head uncoverage improved in both groups (p = .011). No change was found in the radiographic angles in patients undergoing isolated calcaneonavicular bar excision. No patients in either group developed recurrence of the coalition. The results of the present study demonstrated radiographic improvement in patients undergoing calcaneonavicular bar excision with concomitant pes planovalgus reconstruction. Hindfoot reconstruction with joint sparing osteotomies during coalition excision is a reasonable option to improve alignment and avoid arthrodesis.
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Affiliation(s)
- Emily A Quinn
- Foot and Ankle Surgeon, Ankle and Foot Associates, LLC, Tifton, GA
| | - Kyle S Peterson
- Fellowship-Trained Foot and Ankle Surgeon, Suburban Orthopaedics, Bartlett, IL
| | - Christopher F Hyer
- Fellowship Director, Advanced Foot and Ankle Surgical Fellowship, Orthopedic Foot and Ankle Center, Westerville, OH, and Residency Director, Grant Medical Center, Columbus, OH.
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Abstract
Calcaneonavicular coalitions are an important cause of adolescent foot pain and deformity. The congenital condition is characterized by an aberrant osseous, cartilaginous, or fibrinous union of the calcaneal and navicular bones. Calcaneonavicular coalitions are the most common form of tarsal coalitions identified within epidemiologic studies. A thorough understanding of this clinically significant entity is important for restoring joint motion and preventing long-term disability.
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Affiliation(s)
- Stephanie J Swensen
- Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, 301 East 17th Street, New York, NY 10003, USA.
| | - Norman Y Otsuka
- Pediatric Orthopaedics, The Children's Hospital at Montefiore, 3415 Brainbridge Ave., Bronx, NY 10457, USA; Orthopaedic Surgery and Pediatrics, Albert Einstein College of Medicine, 1300 Morris Park Ave., Bronx, NY 10461, USA
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Dunn KW, Giordano AR. Surgical Resection of Bilateral Coalition of the Third and Fourth Metatarsals: A Case Report. J Foot Ankle Surg 2015; 55:1038-42. [PMID: 26232885 DOI: 10.1053/j.jfas.2015.06.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Indexed: 02/03/2023]
Abstract
An intermetatarsal coalition is an uncommon pathologic entity, previously reported in published studies as being primarily unilateral, most commonly between the first and second metatarsals and less so between the third and fourth metatarsals. We report an unusual case of a bilateral coalition of the third and fourth metatarsals in a 43-year-old male who presented with nonspecific dorsolateral foot pain. Conservative therapy initially failed, and resolution of pain was noted bilaterally after coalition resection.
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Affiliation(s)
- Karl W Dunn
- Postgraduate Year III Resident, Henry Ford Macomb Hospital, Clinton Township, MI
| | - Anthony R Giordano
- Private Practice, Foot and Ankle Associates of Michigan, Shelby Township, MI.
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Tower DE, Wood RW, Vaardahl MD. Talocalcaneal Joint Middle Facet Coalition Resection With Interposition of a Juvenile Hyaline Cartilage Graft. J Foot Ankle Surg 2015; 54:1178-82. [PMID: 25922335 DOI: 10.1053/j.jfas.2015.02.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Indexed: 02/03/2023]
Abstract
Talocalcaneal joint middle facet coalition is the most common tarsal coalition, occurring in ≤2% of the population. Fewer than 50% of involved feet obtain lasting relief of symptoms after nonoperative treatment, and surgical intervention is commonly used to relieve symptoms, increase the range of motion, improve function, reconstruct concomitant pes planovalgus, and prevent future arthrosis from occurring at the surrounding joints. Several approaches to surgical intervention are available for patients with middle facet coalitions, ranging from resection to hindfoot arthrodesis. We present a series of 4 cases, in 3 adolescent patients, of talocalcaneal joint middle facet coalition resection with interposition of a particulate juvenile hyaline cartilaginous allograft (DeNovo(®) NT Natural Tissue Graft, Zimmer, Inc., Warsaw, IN). With a mean follow-up period of 42.8 ± 2.9 (range 41 to 47) months, the 3 adolescent patients in the present series were doing well with improved subtalar joint motion and decreased pain, and 1 foot showed no bony regrowth on a follow-up computed tomography scan. The use of a particulate juvenile hyaline cartilaginous allograft as interposition material after talocalcaneal middle facet coalition resection combined with adjunct procedures to address concomitant pes planovalgus resulted in good short-term outcomes in 4 feet in 3 adolescent patients.
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Affiliation(s)
- Dyane E Tower
- Podiatrist, Department of Orthopaedics, Dartmouth-Hitchcock Medical Center, Lebanon, NH; Assistant Professor of Orthopaedics, Geisel School of Medicine at Dartmouth, Hanover, NH.
| | - Ryan W Wood
- Podiatrist, Coachella Valley Foot and Ankle, Rancho Mirage, CA
| | - Michael D Vaardahl
- Podiatrist, Foot and Ankle Center of Northern Colorado, Greeley, CO; Residency Director, North Colorado Medical Center, Greeley, CO
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Schwartz JM, Kihm CA, Camasta CA. Subtalar Joint Distraction Arthrodesis to Correct Calcaneal Valgus in Pediatric Patients with Tarsal Coalition: A Case Series. J Foot Ankle Surg 2015; 54:1151-7. [PMID: 25704449 DOI: 10.1053/j.jfas.2014.09.036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2013] [Indexed: 02/03/2023]
Abstract
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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Affiliation(s)
| | - Carl A Kihm
- Department of Podiatry, DeKalb Medical Center, Decatur, GA
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Zhou B, Tang K, Hardy M. Talocalcaneal coalition combined with flatfoot in children: diagnosis and treatment: a review. J Orthop Surg Res 2014; 9:129. [PMID: 25499625 PMCID: PMC4276075 DOI: 10.1186/s13018-014-0129-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2014] [Accepted: 11/24/2014] [Indexed: 01/28/2023] Open
Abstract
Talocalcaneal coalition often leads to a flatfoot deformity in children. Previous reports have uncovered many aspects of tarsal coalition and flatfoot respectively, including the etiology, clinical presentation, and diagnostic imaging, as well as treatment. However, the optimum surgical procedure for talocalcaneal coalition combined with flatfoot has not been definitively determined. The nonconformity of treatment options is due to our incomplete knowledge of biomechanics, diagnosis, and indication of treatment for talocalcaneal coalition with flatfoot. The objectives of this review are to provide an overview of the current knowledge about etiology, biomechanics, classification, diagnosis, and treatment options for talocalcaneal coalitions with flatfoot and highlight its therapies in children.
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Affiliation(s)
- Binghua Zhou
- Department of Orthopedic Surgery, Third Military Medical University Affiliated Southwest Hospital, Gaotanyan Str. 30, Chongqing, 400038, People's Republic of China.
| | - Kanglai Tang
- Department of Orthopedic Surgery, Third Military Medical University Affiliated Southwest Hospital, Gaotanyan Str. 30, Chongqing, 400038, People's Republic of China.
| | - Mark Hardy
- Department of Foot & Ankle Surgery, HealthSpan Physicians Group, 10 Severance Circle, Cleveland Heights, OH, 44118, USA.
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El Shazly O, Mokhtar M, Abdelatif N, Hegazy M, El Hilaly R, El Zohairy A, Tawfik E. Coalition resection and medial displacement calcaneal osteotomy for treatment of symptomatic talocalcaneal coalition: functional and clinical outcome. INTERNATIONAL ORTHOPAEDICS 2014; 38:2513-7. [PMID: 25248861 DOI: 10.1007/s00264-014-2535-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Accepted: 09/09/2014] [Indexed: 11/29/2022]
Abstract
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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Carli A, Leblanc E, Amitai A, Hamdy RC. The Evaluation and Treatment of Pediatric Tarsal Coalitions: A Critical Analysis Review. JBJS Rev 2014; 2:01874474-201408000-00002. [PMID: 27490073 DOI: 10.2106/jbjs.rvw.m.00112] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Alberto Carli
- Division of Orthopaedics, Shriners Hospital for Children, Montreal Children's Hospital, McGill University, 1529 Cedar Avenue, Montreal, Quebec, Canada H3G 1A6
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Hentges MJ, Moore KR, Catanzariti AR, Derner R. Procedure selection for the flexible adult acquired flatfoot deformity. Clin Podiatr Med Surg 2014; 31:363-79. [PMID: 24980927 DOI: 10.1016/j.cpm.2014.03.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Adult acquired flatfoot represents a spectrum of deformities affecting the foot and the ankle. The flexible, or nonfixed, deformity must be treated appropriately to decrease the morbidity that accompanies the fixed flatfoot deformity or when deformity occurs in the ankle joint. A comprehensive approach must be taken, including addressing equinus deformity, hindfoot valgus, forefoot supinatus, and medial column instability. A combination of osteotomies, limited arthrodesis, and medial column stabilization procedures are required to completely address the deformity.
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Affiliation(s)
- Matthew J Hentges
- Division of Foot and Ankle Surgery, West Penn Hospital, Allegheny Health Network, 4800 Friendship Avenue, Pittsburgh, PA 15224, USA
| | - Kyle R Moore
- Division of Foot and Ankle Surgery, West Penn Hospital, Allegheny Health Network, 4800 Friendship Avenue, Pittsburgh, PA 15224, USA
| | - Alan R Catanzariti
- Division of Foot and Ankle Surgery, West Penn Hospital, Allegheny Health Network, 4800 Friendship Avenue, Pittsburgh, PA 15224, USA.
| | - Richard Derner
- Private Practice, Associated Foot and Ankle Centers of Northern Virginia, 1721 Financial Loop, Lake Ridge, VA 22192, USA
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Chua C, Yeap E, Yazid M. Subtalar coalition: a case report. Malays Orthop J 2013; 7:27-9. [PMID: 25674305 PMCID: PMC4322140 DOI: 10.5704/moj.1311.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Subtalar coalition is an uncommon condition that usually
manifests in early adolescence(1). Frequently, this condition
is missed. Delayed diagnosis may result in osteoarthritis
requiring triple arthrodesis. Here, we report two patients with
subtalar coalition. The first patient is a 12 year old boy who
presented with right ankle pain for one year and was treated
with excision of the coalition and bone wax insertion at the
excision site. We followed up the patient for two years and
the result was excellent with full range of movement of his
right ankle and subtalar joint attained within two months. He
returned to athletic activity by six months and was
discharged with no complications after two years. The
second patient is a 15 year old girl who presented with
bilateral ankle pain and swelling for three years and was
treated with excision of the coalition and subtalar
interpositional arthroplasty bilaterally. She defaulted follow
up after seven months as she was very satisfied with the
result. We wish to highlight this condition which may be
misdiagnosed as flexible flat foot or ankle sprain.
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Affiliation(s)
- Cg Chua
- Department of Orthopaedics and Traumatology, Hospital Tuanku Fauziah, Kangar, Perlis
| | - Ej Yeap
- Perlis Clinical Research Centre, Hospital Tuanku Fauziah, Kangar, Perlis
| | - M Yazid
- Department of Orthopaedics and Traumatology, Hospital Tuanku Fauziah, Kangar, Perlis
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Warnock AM, Raducanu R, DeHeer PA. Lower extremity pediatric history and physical examination. Clin Podiatr Med Surg 2013; 30:461-78. [PMID: 24075130 DOI: 10.1016/j.cpm.2013.07.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Although the pediatric foot and ankle examination is essentially similar to that of the adult patient, there are subtle differences unique to a child's examination. The unique findings are discussed in this article based on the following: weight-bearing examination, gait evaluation, non-weight-bearing examination, vascular examination, neurologic examination, and dermatologic examination for pediatric patients. A comprehensive overview is provided; however, other challenges presented in evaluating children include management of a child's parents and a child's temperament. The setting for an examination and a child's mood must be taken into consideration to ensure a successful outcome.
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Affiliation(s)
- Aaron M Warnock
- Hoosier Foot & Ankle, LLC, 1159 West Jefferson Street, Suite 204, Franklin, IN 46131, USA
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Ultrasound of talocalcaneal coalition: retrospective study of 11 patients. Skeletal Radiol 2013; 42:1209-14. [PMID: 23644879 DOI: 10.1007/s00256-013-1628-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2012] [Revised: 03/19/2013] [Accepted: 04/14/2013] [Indexed: 02/02/2023]
Abstract
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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