The too-long anterior process and osteochondral lesion of the talus: Is there an anatomical predisposition? A case-control study on 135 feet

INTRODUCTION

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

METHODS

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

RESULTS

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

DISCUSSION

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

LEVEL OF EVIDENCE

III.

Diagnosing tarsal coalition in medieval Exeter

OBJECTIVE

The objective of this study is to estimate the frequency and types of tarsal coalition represented in medieval remains from Exeter, England.

MATERIALS

183 individuals from the Cathedral Green site in Exeter, England.

METHODS

Gross macroscopic analysis combined with radiographic examination and comparison with clinical and archaeological literature.

RESULTS

Eight coalitions of various forms were ultimately identified; these include five calcaneonavicular, one talocalcaneal, one calcaneocuboid, and one lateral cuneiform-third metatarsal coalition.

CONCLUSIONS

These frequencies are quite high for clinical imaging estimations, but consistent with other reported archaeological frequencies.

SIGNIFICANCE

This study contributes to known frequencies of tarsal coalition in the past. It also provides descriptive diagnostic criteria for identifying tarsal coalition in archaeological populations.

LIMITATIONS

Poor preservation of some of the individuals in this sample means that the true frequencies of tarsal coalition may be underrepresented.

SUGGESTIONS FOR FURTHER RESEARCH

This study should be expanded to include more archaeological sites, especially medieval British sites, to determine overall prevalence rates. Additionally, the diagnostic criteria should be compared with other examples of known tarsal coalition to further our understanding of this rare pathology.

A rare presentation of foot pain: bilateral navicular-medial cuneiform coalition

In this case report, we discuss a rare tarsal coalition occurring bilaterally between the navicular and the medial cuneiform in a 15-year-old girl and highlight the management of such cases.

Coalition resection and medial displacement calcaneal osteotomy for treatment of symptomatic talocalcaneal coalition: functional and clinical outcome

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.

Percutaneous resection of calcaneo-navicular coalition with interposition of synthetic graft

BACKGROUND

Surgical resection of calcaneo-navicular coalition (CNC) with interposition of fat or muscle graft is indicated when there is failure of conservative treatment.

OBJECTIVES

to evaluate the clinical and functional of outcome of a new mini-invasive technique for resection of CNC and interposition of synthetic graft.

METHODS

This is a prospective case series study on 9 patients (12 feet) with symptomatic CNC. Percutaneous resection of the CNC was done using a motorized bone burr through a small incision in the sinus tarsi under image intensifier control. After complete resection a synthetic graft of Teflon or Dacron measuring 15 mm × 30 mm was interposed to prevent re-union of the bone bar.

RESULTS

The mean follow up period was 26.44 months (±1.5 SD). There was statistically significant improvement in the mean total AOFAS score from 47.89 (±8.49 SD) preoperatively to 90.22 (± 5.26 SD) at two years follow up (P<0.05). The mean time to return to full daily activity was 7.44 weeks (±0.88 SD) CONCLUSION: Percutaneous resection of calcaneo-navicular bar with interposition of synthetic graft is an effective mini-invasive method for treatment of calcaneo-navicular coalition with good results in 44.4% of patients and excellent results in 55.6% of patients.

Preliminary report: resection and interposition of a deepithelialized skin flap graft in tarsal coalition in children

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