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Marth AA, Feuerriegel GC, Marcus RP, Sutter R. How accurate is MRI for diagnosing tarsal coalitions? A retrospective diagnostic accuracy study. Eur Radiol 2024; 34:3493-3502. [PMID: 37855854 PMCID: PMC11126476 DOI: 10.1007/s00330-023-10304-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 08/22/2023] [Accepted: 09/04/2023] [Indexed: 10/20/2023]
Abstract
OBJECTIVES This study aimed to evaluate the diagnostic accuracy, inter-reader agreement, and associated pathologies on MR images of patients with confirmed TC. METHODS AND MATERIALS In this retrospective study, 168 ankle MRI exams were included, consisting of 56 patients with clinically or surgically confirmed TC and 112 controls without TC, matched for age and sex. Images were analyzed independently by three radiologists blinded to clinical information. The evaluation criteria included the presence, type, and location of TC, as well as associated pathologies. After calculating diagnostic accuracy and the odds ratio of demographic data and anatomic coalition type for associated pathologies, inter-reader agreement was assessed using kappa statistics. RESULTS The majority of TCs were non-osseous (91.1%) and located at the calcaneonavicular (33.9%) or talocalcaneal joint (66.1%). Associated pathologies included adjacent and distant bone marrow edema (57.1% and 25.0%), osteochondral defect of the talar dome (OCD, 19.6%), and joint effusion (10.7%) and accessory anterolateral talar facet (17.9%). Talar OCD was associated with increased patient age (p = 0.03). MRI exhibited a cumulative sensitivity and specificity of 95.8% and 94.3% with almost perfect inter-reader agreement (κ = 0.895). CONCLUSION MRI is a reliable method for detecting tarsal coalition and identifying commonly associated pathologies. Therefore, we recommend the routine use of MRI in the diagnostic workup of patients with foot pain and suspected tarsal coalition. CLINICAL RELEVANCE STATEMENT MRI is an accurate and reliable modality for diagnosing tarsal coalitions and detecting associated pathologies, while improving patient safety compared to computed tomography by avoiding radiation exposure. KEY POINTS • Despite the technological progress in magnetic resonance imaging (MRI), computed tomography (CT) is still regarded as the gold standard for diagnosing tarsal coalition (TC). • MRI had a cumulative sensitivity of 95.8% and specificity of 94.3% for detecting tarsal coalition with an almost perfect inter-reader agreement. • MRI demonstrates high accuracy and reliability in diagnosing tarsal coalitions and is useful for identifying associated pathologies, while also improving patient safety by avoiding radiation exposure.
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Affiliation(s)
- Adrian A Marth
- Department of Radiology, Balgrist University Hospital, Faculty of Medicine, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland.
- Swiss Center for Musculoskeletal Imaging, Balgrist Campus AG, Zurich, Switzerland.
| | - Georg C Feuerriegel
- Department of Radiology, Balgrist University Hospital, Faculty of Medicine, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Roy P Marcus
- Department of Radiology, Balgrist University Hospital, Faculty of Medicine, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Reto Sutter
- Department of Radiology, Balgrist University Hospital, Faculty of Medicine, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
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Myerson MS, Fernández-Rojas E, Rosa MMDL, Araya-Bonilla V, Barra-Dinamarca E, Elgueta-Grillo J. Talocalcaneal coalition classifications: A critical analysis review and suggested new classification system with implications for treatment. Foot Ankle Surg 2024:S1268-7731(24)00070-5. [PMID: 38584062 DOI: 10.1016/j.fas.2024.03.010] [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: 10/24/2023] [Revised: 02/25/2024] [Accepted: 03/19/2024] [Indexed: 04/09/2024]
Abstract
Talocalcaneal coalitions (TCC) is the second most frequent tarsal coalition reported. Our aim was to review talocalcaneal coalition classifications and to propose a new classification emphasizing a therapeutic approach. None of the classifications described for TCC mention the presence of flatfoot or valgus hindfoot, which are the key elements when defining the optimal treatment of this disease. We defined five clinical and radiological factors that would guide the choice of surgical treatment and based on these, we proposed a new classification system.
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Affiliation(s)
- Mark S Myerson
- Orthopedic Surgery, University Colorado, President and Founder Steps2Walk, United States
| | - Enrique Fernández-Rojas
- Foot and Ankle Group, Traumatology and Orthopedics Unit, Las Higueras Hospital, Talcahuano. 777 Alto Horno St., Talcahuano 4260000, Chile; School of Medicine, Catholic University of the Most Holy Conception, 2850 Alonso de Ribera St., Concepción 4030000, Chile.
| | - Manuel Monteagudo de la Rosa
- Orthopedic Foot and Ankle Unit. Quirónsalud Madrid Hospital, 1 Diego de Velázquez St., Pozuelo de Alarcón, Madrid 28223, Spain
| | - Víctor Araya-Bonilla
- Foot and Ankle Group, Traumatology and Orthopedics Unit, Las Higueras Hospital, Talcahuano. 777 Alto Horno St., Talcahuano 4260000, Chile; School of Medicine, Catholic University of the Most Holy Conception, 2850 Alonso de Ribera St., Concepción 4030000, Chile
| | - Emilio Barra-Dinamarca
- Foot and Ankle Group, Traumatology and Orthopedics Unit, Las Higueras Hospital, Talcahuano. 777 Alto Horno St., Talcahuano 4260000, Chile
| | - Jaime Elgueta-Grillo
- Foot and Ankle Group, Traumatology and Orthopedics Unit, Las Higueras Hospital, Talcahuano. 777 Alto Horno St., Talcahuano 4260000, Chile; School of Medicine, Catholic University of the Most Holy Conception, 2850 Alonso de Ribera St., Concepción 4030000, Chile
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3
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Hansford BG, Li NP, Stacy GS, Mills MK, Tommack M, Yablon CM. Cubonavicular Coalition: Magnetic Resonance Imaging Findings and Associated Pathology of a Rarely Reported Condition in 27 Patients. Acad Radiol 2024; 31:846-856. [PMID: 37684180 DOI: 10.1016/j.acra.2023.08.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 07/21/2023] [Accepted: 08/09/2023] [Indexed: 09/10/2023]
Abstract
RATIONALE AND OBJECTIVES (1) Describe multimodality imaging of cubonavicular coalition (CNC) with magnetic resonance imaging (MRI) focus, (2) evaluate CNC associated foot and ankle pathology, (3) examine clinical presentation/symptoms associated with CNC, (4) record CNC treatment. MATERIALS AND METHODS Retrospective Institutional Review Board (IRB) approved study. Picture Archiving and Communication System (PACS) databases searched for CNC. Final study population: 34 cases in 27 patients. Each CNC was reviewed for: coalition type (osseous versus non-osseous- cartilaginous versus fibrous), tendon and ligament pathology, bone marrow edema at CNC and adjacent joints, presence and severity of degenerative changes at CNC and adjacent joints, fractures, additional coalitions, laterality, and pes planus. MRI planes and radiographic views on which coalitions were best identified were recorded. Each CNC EMR was reviewed for: symptoms, trauma, management, patient demographics. Inter-reader reliability was performed for type of non-osseous coalition. RESULTS Final cohort included 34 cases in 27 patients (average age: 34.7, range: 10-76; 71% female). No CNC was completely osseous. On MRI, 89.5% of coalitions were non-osseous and 5.3% were partially osseous. 76.5% of patients had referable symptoms including pain, limited motion, inability to bear weight. 23.5% of patients were surgically managed/pathologically proven. On MRI, 36.8% of patients had tendon pathology, 52.6% had ligamentous pathology, 100% had bone marrow edema-like signal abnormality about the CNC, and 88.2% had CNC degenerative changes. There was bone marrow edema-like signal abnormality at bones adjacent to the CNC in 52.6% and adjacent joint degenerative disease present in 50%. CNC was best identified on oblique radiographs and axial MRI. Inter-reader reliability for non-osseous coalition type was poor, Cronbach's alpha 0.554. CONCLUSION CNC is subtle and findings of osteoarthritis or bone marrow edema-like about the cubonavicular articulation should raise suspicion for underlying coalition.
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Affiliation(s)
- Barry G Hansford
- Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239.
| | - Ningcheng Peter Li
- Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239
| | | | - Megan K Mills
- University of Utah Hospitals, Salt Lake City, Utah (M.K.M.)
| | | | - Corrie M Yablon
- University of Michigan Hospitals, Ann Arbor, Michigan (C.M.Y.)
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4
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Ali Mousa A, Howaidy AEF, Mohamed AF, Abd-Ella MM. Coalition excision and corrective osteotomies versus coalition excision and arthroereisis in management of pes planovalgus with talo-calcaneal coalition in adolescents: A randomized controlled trial. Foot Ankle Surg 2023; 29:466-474. [PMID: 37451927 DOI: 10.1016/j.fas.2023.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 03/05/2023] [Accepted: 06/24/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Talocalcaneal coalition is the most common cause of rigid flat foot in adolescents. It presents with recurrent ankle sprains, foot and ankle pain, and foot deformity. Management is still controversial. Multiple options were utilized during the last 40 years, including coalition excision only or coalition excision with hind foot arthrodesis or corrective osteotomies. However, the effect of arthroereisis after coalition excision is still questionable. PATIENTS AND METHODS Thirty feet in 28 patients with rigid flat foot due to talocalcaneal coalition, who presented to our institution between September 2018 and April 2020, were prospectively analyzed. Randomization was performed by random allocation using a computer-based system into two groups: group A for coalition excision and arthroereisis, group B for coalition excision and osteotomies. Functional and radiological outcomes and complications were recorded and analyzed using Statistical Package for the Social Sciences software. RESULTS Thirty feet in 28 patients were included in the final analysis (15 feet in each group). One patient in each group had bilateral affection. The mean age was 14.5 years, and the mean follow-up duration was 24 months. At final follow-up, the mean AOFAS was 78.8 ± 4.04 in group A and 76.73 ± 4.66 in group B, while the FAAM scores were 80 ± 5 and 79 ± 3 in groups A and B, respectively. The complication rate was higher in group A, however with no statistical significance. CONCLUSION The combination of talocalcaneal coalition resection with either corrective osteotomies or arthroereisis had a significant improvement of functional and radiological outcomes in the management of rigid pes planovalgus.
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Affiliation(s)
- Awab Ali Mousa
- Department of Orthopedic surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
| | | | - Amr Farouk Mohamed
- Department of Orthopedic surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
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Garg V, Nasim O, Kumar S, Khan MN, Durrani A, Karim A. Resection of Bar in the Management of Calcaneonavicular Coalition: A Systematic Review. Cureus 2023; 15:e39275. [PMID: 37346201 PMCID: PMC10279521 DOI: 10.7759/cureus.39275] [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: 05/20/2023] [Indexed: 06/23/2023] Open
Abstract
The most commonly encountered type of tarsal coalition in symptomatic patients is the calcaneonavicular coalition. Non-surgical treatments are effective for most patients. However, if surgery is required, excision of the calcaneonavicular bar can be a successful option that preserves hindfoot mobility and function. We conducted a systematic review of calcaneonavicular bar excision in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) checklist. To conduct the review, we conducted a thorough search of several databases, including PubMed, Cochrane, Excerpta Medica Database (EMBASE), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Google Scholar, and bibliographies. We analyzed the chosen studies to collect information on patient demographics, clinical outcomes, surgical techniques, and potential complications. We identified 11 studies that included 274 patients for a total of 394 feet. The average age of patients in these studies was 12.5 years, ranging from 8.2 to 19.4 years. Follow-up periods varied from 2.3 to 23 years, with an average duration of 5.9 years. Excision of the calcaneonavicular bar was performed at 380 feet, while fusion was performed at 14 feet. In 50.5% of the feet, the extensor digitorum brevis was used as an interposition material. Successful outcomes after bar excision were observed in 82.9% of cases (304 feet) and were described as satisfactory, improved, good, or excellent outcomes. In one study, the American Orthopaedic Foot and Ankle Society (AOFAS) score improved from 47.89 to 90.22 in 12 feet after bar excision. Recurrence was reported in 52 feet out of the 380 feet that underwent bar excision. Progression of arthritis in the ankle and subtalar joint was reported in 25 feet. Various complications were reported, including paraesthesia in the hindfoot (three feet), midfoot pain (three feet), hindfoot pain (two feet), mild wound infection (one foot), and swelling and stiffness (one foot). Surgical excision of the calcaneonavicular bar has shown successful outcomes in most patients, regardless of the use of interposition material. These outcomes are associated with minimal and acceptable complications. However, since the studies conducted in the literature were single-center retrospective and prospective trials, a multicenter prospective study with patient-centered, validated outcomes would provide a better opportunity to support the evidence in favor of surgical excision of the calcaneonavicular bar. Overall, the use of various interposition materials is associated with reduced chances of recurrence compared to cases where no interposition material was used.
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Affiliation(s)
- Vipul Garg
- Trauma and Orthopaedics, Wrexham Maelor Hospital, Wrexham, GBR
| | - Omer Nasim
- Trauma and Orthopaedics, Poole General Hospital, Poole, GBR
| | - Sanjay Kumar
- Trauma and Orthopaedics, Gloucestershire Royal Hospital, Gloucestershire, GBR
| | - Mohammad Noah Khan
- Trauma and Orthopaedics, University Hospitals Dorset NHS Foundation, Poole, GBR
| | - Abdullah Durrani
- Trauma and Orthopaedics, University Hospitals Dorset NHS Foundation, Poole, GBR
| | - Arsallan Karim
- Trauma and Orthopaedics, University Hospitals Dorset NHS Foundation, Poole, GBR
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6
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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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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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8
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Lopes R, Bauer T. Lateral endoscopy of the sinus tarsi: Anatomy, technique and current indications. Orthop Traumatol Surg Res 2022; 108:103383. [PMID: 35926723 DOI: 10.1016/j.otsr.2022.103383] [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: 03/20/2022] [Revised: 06/06/2022] [Accepted: 06/22/2022] [Indexed: 02/03/2023]
Abstract
Numerous pathologies are reported in the lateral mid- and hind-foot. Access to the sinus tarsi is difficult, making lateral endoscopy the preferred approach. The present technical note describes the anatomy, technique and current indications for lateral endoscopy of the sinus tarsi.
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Affiliation(s)
- Ronny Lopes
- Clinique Brétéché, 3, Rue de la Béraudière, 44000 Nantes, France; Polyclinique de l'Atlantique, avenue Claude-Bernard, 44800 Saint-Herblain, France.
| | - Thomas Bauer
- Service de chirurgie orthopédique, hôpital Ambroise-Paré, hôpitaux Universitaires Paris Île-de-France Ouest, 9, avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France
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9
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Saxena A, Allen R, Wright A, Migliorini F, Maffulli N. Tarsal coalition resections: a long-term retrospective analysis of 97 resections in 78 patients. J Orthop Surg Res 2022; 17:458. [PMID: 36253856 PMCID: PMC9575301 DOI: 10.1186/s13018-022-03350-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 10/07/2022] [Indexed: 11/15/2022] Open
Abstract
Background Resection of tarsal coalitions provides good patient satisfaction scores, reduced pain, and improved long-term function in both athletic and non-athletic populations. This study aimed to determine when athletic patients undergoing resection of a tarsal coalition were able to return to their desired activity, and whether they experienced a decreased desired activity level (DDA).
Methods Data on a total of 78 patients who underwent 97 tarsal coalition resections (49 talocalcaneal coalitions, 47 calcaneo-navicular, 14 cuboid-navicular, and three cuneo-navicular; some patients had more than one coalition) operated between January 2001 and June 2020 were prospectively collected. To subjectively assess outcomes, the Roles and Maudsley score (RM) was utilized. Results At an average follow-up from the index procedure of 33.6 ± 41.5 months, return to activity for the entire cohort was 18.3 ± 9.6 weeks. Post-RM was 1.3 ± 0.6. Conclusion Surgical excision of tarsal coalitions produced favorable results, with most patients able to return to their desired activity level. Level of evidence IV.
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Affiliation(s)
- Amol Saxena
- Department of Sports Medicine, Palo Alto Medical Foundation, Palo Alto, CA, USA
| | - Ryan Allen
- Seal Beach Podiatry Group, Alamitos, CA, USA
| | | | - Filippo Migliorini
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074, Aachen, Germany. .,Department of Orthopaedic and Trauma Surgery, Eifelklinik St. Brigida, 52152 Simmerath, Germany.
| | - Nicola Maffulli
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Salerno, Italy.,Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, 275 Bancroft Road, London, E1 4DG, England.,School of Pharmacy and Bioengineering, Keele University School of Medicine, Thornburrow Drive, Stoke on Trent, England
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10
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Hollander JJ, Dusoswa QF, Dahmen J, Sullivan N, Kerkhoffs GMMJ, Stufkens SAS. 8 out of 10 patients do well after surgery for tarsal coalitions: A systematic review on 1284 coalitions. Foot Ankle Surg 2022; 28:1110-1119. [PMID: 35397990 DOI: 10.1016/j.fas.2022.03.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 03/03/2022] [Accepted: 03/21/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND The primary aim was to determine the clinical success rate after treatment for talocalcaneal (TCC) and calcaneonavicular coalitions (CNC). The secondary aim was to evaluate the complication, recurrence and revision rate. METHODS A search was carried out in MEDLINE, EMBASE and Cochrane Library. Methodological quality was assessed using the Methodological Index for Non-Randomised Studies (MINORS) criteria. The primary outcome was the clinical success rate and was pooled per type of coalition and treatment modality. 95% Confidence Intervals (CI) of the success rates were calculated. Secondary outcomes included complication rates, coalition recurrence rates, revision rates and pain improvement using the Visual Analogue Scale (VAS). A sub-analysis on interposition material was performed. RESULTS 43 articles comprising of 1284 coalitions were included, with a pooled mean follow-up of 51 months. Methodological quality was fair. The overall pooled success rate for TCCs was 79% (95% CI, 75%-83%). Conservative treatment, open resection and arthroscopic resection of TCCs resulted in success rates of 58% (95% CI, 42%-73%), 80% (95% CI, 76%-84%) and 86% (95% CI, 71%-94%), respectively. CNCs have an overall success rate of 81% (95% CI, 75%-85%), with 100% (95% CI, 34%-100%), 80% (95% CI, 74%-85%) and 100% (95% CI, 65%-100%) for conservative treatment, open resection and arthroscopic resection, respectively. Pooled complication rates of 4% (95% CI, 3%-7%) for TCCs and 6% (95% CI, 4%-11%) for CNCs were found. The success rates of resection with and without interposition material for TCCs were 83% (95% CI, 78%-87%) and 79% (95% CI, 65%-88%), and for CNCs 81% (95% CI, 76%-86%) and 69% (95% CI, 44%-85%), respectively. CONCLUSION Treatment of tarsal coalitions can be considered good to excellent as well as safe, with an overall clinical success rate of 79% for TCCs and 81% for CNCs. Arthroscopic resection of the coalition appears to be non-inferior to open resection of TCCs and CNCs. LEVEL OF EVIDENCE Level IV, Systematic Review.
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Affiliation(s)
- Julian J Hollander
- Department of Orthopaedic Surgery, Amsterdam Movement Sciences, Amsterdam UMC, Location AMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; Academic Center for Evidence based Sports medicine (ACES), Amsterdam UMC, Amsterdam, The Netherlands; Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center, Amsterdam UMC, Amsterdam, The Netherlands
| | - Quinten F Dusoswa
- Department of Orthopaedic Surgery, Amsterdam Movement Sciences, Amsterdam UMC, Location AMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; Academic Center for Evidence based Sports medicine (ACES), Amsterdam UMC, Amsterdam, The Netherlands; Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center, Amsterdam UMC, Amsterdam, The Netherlands
| | - Jari Dahmen
- Department of Orthopaedic Surgery, Amsterdam Movement Sciences, Amsterdam UMC, Location AMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; Academic Center for Evidence based Sports medicine (ACES), Amsterdam UMC, Amsterdam, The Netherlands; Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center, Amsterdam UMC, Amsterdam, The Netherlands
| | - Nicholas Sullivan
- Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States
| | - Gino M M J Kerkhoffs
- Department of Orthopaedic Surgery, Amsterdam Movement Sciences, Amsterdam UMC, Location AMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; Academic Center for Evidence based Sports medicine (ACES), Amsterdam UMC, Amsterdam, The Netherlands; Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center, Amsterdam UMC, Amsterdam, The Netherlands
| | - Sjoerd A S Stufkens
- Department of Orthopaedic Surgery, Amsterdam Movement Sciences, Amsterdam UMC, Location AMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; Academic Center for Evidence based Sports medicine (ACES), Amsterdam UMC, Amsterdam, The Netherlands; Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center, Amsterdam UMC, Amsterdam, The Netherlands.
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11
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Muacevic A, Adler JR. Talocalcaneal Coalition Resection in the Adult Population: A Systematic Review. Cureus 2022; 14:e30581. [PMID: 36299599 PMCID: PMC9587751 DOI: 10.7759/cureus.30581] [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] [Accepted: 10/22/2022] [Indexed: 11/05/2022] Open
Abstract
Tarsal coalition is a congenital malformation of the tarsal bones of the foot that typically presents with features such as pain, recurrent sprains, and flat foot in childhood. In a small number of patients, a delayed presentation may be apparent, with symptoms instead presenting in adulthood. The most commonly accepted hypothesis is that the tarsal coalition becomes more symptomatic as the coalition progressively ossifies. To this date, no author has systematically evaluated the literature to identify the best approach when surgically managing these patients, in particular concerning the resection of the coalition. This study aims to systematically review the literature, searching EMBASE, MEDLINE, Web of Science, Google Scholar, and the Cochrane Library to identify and evaluate studies that presented an outcome for resection of the adult talocalcaneal coalition. Alongside overall outcomes, details on the extent of the coalition, surgical method, post-operative regimen, and presenting symptoms were extracted for each patient studied. This was conducted in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. With 72 patients, this is the largest evaluation of an adult tarsal coalition population to date. Our findings indicate that talocalcaneal coalition in adulthood presents differently from the classical peroneal spasm found in childhood. Better scores were reported for coalitions either managed with an endoscopic approach or with interposition of the flexor hallucis longus tendon. Despite some reported benefits in the literature, a trial of conservative management or the use of a rehabilitation regimen had a limited impact on the overall patient outcome. Tarsal coalition in adulthood requires rigorous clinical evaluation to identify appropriate management options. Resection of the coalition is a safe approach to definitively managing these patients, but consideration should be given to the surgical method to ensure each patient has the best outcomes. In particular, consideration should be given to using an endoscopic approach or interposition of the flexor hallucis longus tendon in order to achieve the best patient outcomes. However, there remains a paucity of literature evaluating this demographic and further high-impact studies are required to comprehensively evaluate this population.
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Lateral Arthroscopic Subtalar Arthrodesis for Talocalcaneal Coalition: Surgical Technique. Arthrosc Tech 2022; 11:e1403-e1407. [PMID: 36061464 PMCID: PMC9437468 DOI: 10.1016/j.eats.2022.03.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 03/13/2022] [Indexed: 02/03/2023] Open
Abstract
Resection of symptomatic talocalcaneal coalitions (TCCs) has been performed for patients with normal tarsal joints and <50% involvement of the subtalar joint. For those with TCCs >50% of subtalar articulation or/and subtalar arthritis, a subtalar arthrodesis is done. The purpose of this Technical Note is to describe the arthroscopic resection of TCC and talocalcaneal arthrodesis during the same procedure by using a 2 lateral portal technique. With the patient in lateral decubitus under general or locoregional anaesthesia, the foot and ankle are extended beyond the edge of the surgical table. A lateral portal is created 1 cm anterior to the tip of the lateral malleolus in which the arthroscope is introduced. The anterolateral portal is created 1 cm inferior and 2 cm anterior to the tip of the lateral malleolus. The posterior subtalar surface is prepared progressively. The TCC resection is completed. The fixation is obtained with 2 cannulated screws. The arthroscopic resection of TCC and subtalar arthrodesis during the same procedure by using 2 lateral portals can be done for correctly selected patients.
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The Efficacy of Intra-articular Subtalar Steroid Injection for Symptomatic Talocalcaneal Coalitions: A 30-Year Single Institution Experience. J Pediatr Orthop 2022; 42:e453-e458. [PMID: 35250016 DOI: 10.1097/bpo.0000000000002132] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE While intra-articular steroid injection has been used anecdotally in patients with symptomatic talocalcaneal coalitions recalcitrant to traditional conservative modalities, the ability of this treatment to provide symptomatic relief and obviate or delay surgical intervention remains unknown. The purpose of this study is, therefore, to assess the treatment efficacy of intra-articular subtalar steroid injection in children with symptomatic talocalcaneal coalitions. METHODS A retrospective study of all patients with isolated subtalar coalitions was performed at a single pediatric orthopaedic institution over a 30-year period. Radiographs were analyzed to identify the type of coalition (osseous or nonosseous), presence of any posterior facet involvement, and presence of a planovalgus foot deformity. Patients who underwent a subtalar joint steroid injection after failing other conservative treatments were identified and compared with those who did not receive an injection as part of their nonoperative management with regard to the need for ultimate surgical intervention and the time from presentation to surgery when applicable. RESULTS A total of 83 patients (125 feet) met inclusion criteria, of whom 25 patients (34 feet) received a subtalar steroid injection. When compared with the 58 patients (91 feet) treated with standard nonoperative modalities, there were no differences with regard to sex, age at presentation (12.4 and 12.3 y, respectively), facet involvement, type of coalition, or the presence of a planovalgus deformity. In all, 12/34 (35%) feet in the injection group eventually elected surgical intervention compared with 36/91 (39%) feet that did not receive an injection (P=0.72). For those patients ultimately selecting surgical intervention, the average time from initial presentation to surgery was 878 days in the injection group versus 211 days in the noninjection group (P<0.001). CONCLUSIONS While subtalar steroid injection can alleviate symptoms in some patients with a talocalcaneal coalition, this intervention does not appear to decrease the need for surgery when compared with traditional nonoperative therapies. In patients failing other forms of conservative treatment, subtalar steroid injections can delay surgical intervention by an average of nearly 2 years. LEVEL OF EVIDENCE Level-III-therapeutic study.
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Comparative Analysis of Subtalar Ligaments Between Patients With Talocalcaneal Coalition and Control Subjects Using 3-Dimensional Magnetic Resonance Imaging. J Comput Assist Tomogr 2022; 46:440-446. [DOI: 10.1097/rct.0000000000001290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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15
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Angelis S, Myrgiotis D, Apostolopoulos AP, Mandragos E, Statyris NC, Filippou DK, Michelarakis JΝ. Surgical Removal of Bone Bridge and Interposition of the Extensor Digitorum Brevis in the Treatment of the Calcaneonavicular Coalition in Pediatric Patients. A Case Series, Sh. J Long Term Eff Med Implants 2022; 32:27-37. [DOI: 10.1615/jlongtermeffmedimplants.2022042255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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16
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Cheng KY, Fuangfa P, Shirazian H, Resnick D, Smitaman E. Osteochondritis dissecans of the talar dome in patients with tarsal coalition. Skeletal Radiol 2022; 51:191-200. [PMID: 34160680 DOI: 10.1007/s00256-021-03800-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 04/20/2021] [Accepted: 04/25/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Tarsal coalition is known to cause abnormal talocrural stress, hindfoot malalignment, and ankle sprains. These can all be associated with osteochondritis dissecans (OCD) of the talar dome. We present the first detailed description of a series of talar OCDs occurring in patients with tarsal coalition, with the goal of determining whether there is an increased prevalence of OCDs among patients with tarsal coalition. MATERIALS AND METHODS We studied ankle MRIs in 57 patients with tarsal coalitions, excluding those with a reported inciting traumatic event. The MRIs were performed on magnetic field strengths ranging from 0.3 to 1.5 T and included axial, coronal, and sagittal T1 and T2 or PD fat-suppressed sequences. We evaluated the morphology and location of classically described OCDs in these patients, type and location of concomitant tarsal coalition, and, when available, the presence of pes planus and hindfoot valgus on weight-bearing radiographs. Chi-squared analysis was used to compare categorical variables and a Student's t test was used for parametric continuous variables. Additionally, logistic regression was used to compute the odds ratio of talar OCD associated with patient age, gender, laterality, pes planus status, hindfoot valgus status, and coalition type. RESULTS Eighty-nine percent of tarsal coalitions were non-osseous coalitions and the calcaneonavicular space was the most common site of abnormal tarsal connection (54.4%). In the 29 patients with tarsal coalitions and talar OCDs, OCDs commonly occurred medially (75.9%). In the sagittal plane, talar OCDs occurred centrally, with only one case sparing the central talar dome. The mean surface area of the 29 OCDs was 89.7 mm2. Both osseous coalition and hindfoot valgus were associated with smaller talar OCD mean surface area (p = 0.015 and p = 0.0001, respectively). There was no association between depth and surface area of talar OCD with either coalition location or presence of pes planus (coalition location: p = 0.455 for depth and p = 0.295 for surface area; presence of pes planus: p = 0.593 for depth and p = 0.367 for surface area). CONCLUSION Talar OCD prevalence is higher in patients with tarsal coalition than that reported for the general population. This occurrence may relate to altered biomechanics and repetitive talocrural stress owing to altered subtalar motion, particularly given the findings of increased odds of talar OCD in older patients, as well as weak associations between OCD surface area and both non-osseous coalition and hindfoot alignment. However, we did not find any specific OCD morphologic features attributable to the precise location of the tarsal coalition.
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Affiliation(s)
- Karen Y Cheng
- Department of Radiology, UC San Diego Health, 200 W. Arbor Drive, #8226, San Diego, CA, 92103, USA
| | - Praman Fuangfa
- Department of Diagnostic and Therapeutic Radiology, Ramathibodi Hospital,, Mahidol University, Bangkok, Thailand
| | | | - Donald Resnick
- Department of Radiology, UC San Diego Health, 200 W. Arbor Drive, #8226, San Diego, CA, 92103, USA
| | - Edward Smitaman
- Department of Radiology, UC San Diego Health, 200 W. Arbor Drive, #8226, San Diego, CA, 92103, 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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Xu Z, Zaid HH, Yang M. Pseudomyogenic Hemangioendothelioma of the Talocalcaneal Coalition: A Case Report. J Foot Ankle Surg 2021; 60:1073-1078. [PMID: 34127373 DOI: 10.1053/j.jfas.2021.04.007] [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: 09/24/2020] [Revised: 12/05/2020] [Accepted: 04/04/2021] [Indexed: 02/03/2023]
Abstract
Pseudomyogenic hemangioendothelioma is a rare soft tissue tumor most often found in the lower extremities and predominantly occurring in males. The talocalcaneal coalition is an anatomic anomaly that develops between the talus and calcaneus bones, can cause hindfoot pain and subtalar joint stiffness, and has a prevalence of less than 1%. We present what is to our knowledge the first case report of a 17-year-old male with pseudomyogenic hemangioendothelioma occurring within a talocalcaneal coalition. The patient was treated with local excision of the tumor and the coalition. His American Orthopaedic Foot & Ankle Society ankle/hindfoot score went from 70 preoperatively to 92 at 1 year postoperatively, and he has had no evidence of recurrence at 1 and 3 years postoperatively. These tumors have suggestive but not diagnostic computed tomography, magnetic resonance imaging, and histopathological findings, and they are associated with a uniquely characteristic immunophenotype, including immunochemical reactivity to CD31, FLi-1, INI-1, ERG, and FOSB. Primary treatment of pseudomyogenic hemangioendothelioma most often involves local excision (but can require amputation) and may include adjuvant radiotherapy and/or chemotherapy. It has a relatively favorable prognosis, with a moderate risk of local recurrence and a low risk of metastases. Because metastases have been reported many years after treatment, long-term follow-up is necessary.
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Affiliation(s)
- Zhijie Xu
- Department of Orthopedics, the First Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Hamood Hg Zaid
- Department of Orthopedics, the First Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Maowei Yang
- Department of Orthopedics, the First Hospital of China Medical University, Shenyang, Liaoning Province, China.
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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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20
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Intermetatarsal Coalition: Case Report, Literature Review, and Imaging Findings of an Underrecognized and Underdiagnosed Cause of Foot Pain. Case Rep Radiol 2021; 2021:6667907. [PMID: 33628564 PMCID: PMC7886590 DOI: 10.1155/2021/6667907] [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] [Received: 10/06/2020] [Revised: 01/22/2021] [Accepted: 01/27/2021] [Indexed: 11/17/2022] Open
Abstract
Coalition is defined as abnormal bridging between two bones, and the connection can be osseous or nonosseous. Most coalitions in the foot involve the hindfoot. Intermetatarsal coalition is thought to be much rarer than the more common hindfoot coalitions and has only been reported sporadically in the orthopedic literature. We present two patients with nonosseous intermetatarsal coalition presenting with nonspecific dorsolateral foot pain and describe the imaging findings of intermetatarsal coalition with different modalities. We suspect that whilst rarely described, intermetatarsal coalition is quite likely a more common underrecognized entity than a rare entity. This report is aimed at increasing the awareness of coalition in this location, in the radiology community, particularly the nonosseous ones, given that this condition can be debilitating but treatable.
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21
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Faubel Navarrete E, Sánchez-González M, Vicent V, Puchol E. Endoscopic resection of the calcaneonavicular coalition. Rev Esp Cir Ortop Traumatol (Engl Ed) 2020. [DOI: 10.1016/j.recote.2020.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Abstract
Endoscopic resection of tarsal coalitions is technically feasible for both talocalcaneal and calcaneonavicular coalitions. Careful consideration of each individual patient is necessary before proceeding with endoscopic resection. Endoscopic resection of these coalitions may offer benefits in terms of faster recovery and less wound problems, but this has not been proven. Several case reports and case series appear in the literature and are reviewed here along with the different techniques reported. Better-quality evidence is required to assess the clinically relevant benefits and the recurrence rate for endoscopic resection in comparison with open resection.
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Affiliation(s)
- Andrew King
- Trauma and Orthopaedics Department, Royal Cornwall Hospitals NHS Trust, Royal Cornwall Hospital, Treliske, Truro TR1 3LQ, UK.
| | - Stephen Parsons
- Trauma and Orthopaedics Department, Royal Cornwall Hospitals NHS Trust, Royal Cornwall Hospital, Treliske, Truro TR1 3LQ, UK
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Faubel Navarrete E, Sánchez-González M, Vicent V, Puchol E. Endoscopic resection of the calcaneonavicular coalition. Rev Esp Cir Ortop Traumatol (Engl Ed) 2020; 64:375-379. [PMID: 32792286 DOI: 10.1016/j.recot.2020.06.006] [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: 09/17/2019] [Revised: 04/15/2020] [Accepted: 06/11/2020] [Indexed: 10/23/2022] Open
Abstract
Tarsal coalition has an incidence between 2-5% of the general population, and calcaneonavicular is the most frequent (53%). When conservative treatment fails, surgical resection must be indicated. Endoscopic resection is a less invasive technique and can be considered an alternative with better functional recovery. MATERIAL AND METHODS We performed a retrospective study of the patients with calcaneonavicular coalition operated in our hospital between 2015 and 2018. We performed an endoscopic resection. We used AOFAS scale score for the results. RESULTS We reviewed seven cases for a minimum of 12 months. AOFAS score improved from 42 before surgery to 92. There were no major complications from surgery. We had a patient with dysesthesias in the forefoot that improved at 3 months and a case of local swelling that solved with ice and rest. CONCLUSIONS Endoscopic resection has advantages over open surgery. Offers a great vision and good control of the coalition resection, provides an early rehabilitation, decrease hospital stay, improves cosmetic results and the probability of neuroma is minimum with an adequate control of the technique.
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Affiliation(s)
| | | | - V Vicent
- Hospital Universitario y Politécnico La Fe, Valencia, España
| | - E Puchol
- Hospital Universitario y Politécnico La Fe, Valencia, España
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24
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Hong CH, Lee HS, Lee WS, Kim HK, Won SH, Yeo ED, Jung KJ, Ryu A, Kang JK, Lee DW, Kim WJ. Tarsal tunnel syndrome caused by posterior facet talocalcaneal coalition: A case report. Medicine (Baltimore) 2020; 99:e20893. [PMID: 32590797 PMCID: PMC7328969 DOI: 10.1097/md.0000000000020893] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
RATIONALE Tarsal tunnel syndrome (TTS) is a compressive neuropathy of the posterior tibial nerve and its branches. Tarsal coalition is defined as a fibrous, cartilaginous, or osseous bridging of 2 or more tarsal bones. TTS with tarsal coalition is uncommon. Here, we present a rare example of successful surgical management of TTS with posterior facet talocalcaneal coalition. PATIENT CONCERNS A 74-year-old woman presented with hypoesthesia, numbness, and an intermittent tingling sensation on the plantar area over the right forefoot to the middle foot area. The hypoesthesia and paresthesia of the right foot began 6 years previously and were severe along the lateral plantar aspect. The symptoms were mild at rest and increased during daily activities. Tinel sign was positive along the posteroinferior aspect of the medial malleolus. DIAGNOSIS Lateral ankle radiography showed joint-space narrowing and sclerotic bony changes with a deformed C-sign and humpback sign. Oblique coronal and sagittal computed tomography revealed an irregular medial posterior facet, partial coalition, narrowing, and subcortical cyst formation of the posterior subtalar joint. Magnetic resonance imaging showed an abnormal posterior talocalcaneal coalition compressing the posterior tibia nerve. Electromyography and nerve conduction velocity studies were performed, and the findings indicated that there was an incomplete lesion of the right plantar nerve, especially of the lateral plantar nerve, around the ankle level. INTERVENTIONS Surgical decompression was performed. Intraoperatively, the lateral plantar nerve exhibited fibrotic changes and tightening below the posterior facet talocalcaneal coalition. The coalition was excised, and the lateral plantar nerve was released with soft-tissue dissection. OUTCOMES The patient's symptoms of tingling sensation and hypoesthesia were almost relieved at 4 months postoperatively, but she complained of paresthesia with an itching sensation when the skin of the plantar area was touched. The paresthesia had disappeared almost completely at 8 months after surgery. She had no recurrence of symptoms at the 1-year follow-up. LESSONS The TTS with tarsal coalition is rare. Supportive history and physical examination are essential for diagnosis. Plain radiographs and computed tomography or magnetic resonance imaging are helpful to determine the cause of TTS and verify the tarsal coalition. After diagnosis, surgical excision of the coalition may be appropriate for management with a good outcome.
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Affiliation(s)
- Chang Hwa Hong
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Cheonan, Dongam-gu, Cheonan
| | - Hong Seop Lee
- Department of Foot and Ankle Surgery, Nowon Eulji Medical Center, Eulji University, Nowon-gu
| | - Won Seok Lee
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Seoul, Yongsan-gu, Seoul
| | - Hyun Kwon Kim
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Bucheon, Wonmi-gu, Bucheon
| | - Sung Hun Won
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Seoul, Yongsan-gu, Seoul
| | - Eui Dong Yeo
- Department of Orthopaedic Surgery, Veterans Health Service Medical Center, Seoul
| | - Ki Jin Jung
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Cheonan, Dongam-gu, Cheonan
| | - Aeli Ryu
- Department of Obsterics and Gynecology, Soonchunhyang University Hospital Cheonan, Dongnam-gu, Cheonan
| | - Jin Ku Kang
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University Hospital Cheonan, Dongam-gu, Cheonan
| | - Dhong Won Lee
- Department of Orthopaedic Surgery, Konkuk University Medical Center, Gwangjin-gu, Seoul, Korea
| | - Woo Jong Kim
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Cheonan, Dongam-gu, Cheonan
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Abstract
Middle facet tarsal coalition is one of the commonly seen tarsal coalitions in clinical practice that can cause pain and associated flatfoot deformity. Excision of the coalition is one of the treatment options for symptomatic cases. Although symptoms may subside in children following a period of immobilization, resection should be considered as a treatment alternative for children and adolescents because of the potential for restoration of subtalar joint movement. The indications for excision of the coalition are not consistently reported in the literature, and the procedure is not always easy to perform. In this article, we describe the steps for a successful excision of a middle facet tarsal coalition. Description The incision is marked from 1 cm inferior to the medial malleolus, extending distally to the navicular tuberosity and inferior to the level of the posterior tibial tendon. The coalition is first located by retracting the flexor tendons and the neurovascular bundle. The bone on the surface of the coalition is gradually removed to expose the middle facet. A 2-mm guide pin and a cannulated dilator probe inserted through the sinus tarsi into the tarsal canal that exits anterior to the posterior facet help with identifying the margins of the coalition. The middle facet is then removed either partially or totally, depending on the size, shape, and location of the coalition, until the posterior facet is visualized. Following excision, bone wax is used on the exposed surfaces or fat is inserted to prevent adhesion and recurrent bone formation. If there is an associated flatfoot deformity, additional surgeries, including a medial translational osteotomy or a lateral column lengthening of the calcaneus, a Cotton osteotomy, an arthroereisis, or a calcaneus stop procedure, may be necessary. Alternatives The alternative treatment for managing a middle facet coalition is immobilization of the foot in a boot or cast for 6 to 8 weeks to decrease pain. This will not improve the function of the hindfoot, which remains stiff, but may alleviate pain temporarily. Excision of the coalition in combination with other procedures for correction of the flatfoot is an alternative to an arthrodesis of the subtalar joint and works well in children and adolescents, particularly in those with reasonable subtalar joint flexibility. A triple arthrodesis is rarely performed for an isolated middle facet coalition, even in adults, unless there is peritalar arthritis and more severe abduction of the talonavicular joint with associated stiffness. Rationale The rationale for excision of a middle facet tarsal coalition is to maximize the mobility of the hindfoot, in particular, the subtalar joint. The success of excision of the coalition is associated with the rigidity of the hindfoot and the presence of a flatfoot deformity. The stiffer the hindfoot and the flatter the foot, the less likely is excision of the coalition to be successful. Since the alternative to resection of a middle facet coalition is arthrodesis of the subtalar joint, one must distinguish between feet in which there is mobility, and excision is more likely to be successful, and those that are rigid, for which arthrodesis is preferable. In many feet, however, the size of the coalition is not associated with the flexibility of the hindfoot, and in an extremely rigid hindfoot, we recommend an arthrodesis, even in an adolescent patient. Rigidity increases with increasing age, and it is uncommon to excise the middle facet coalition in adult patients or in a patient in whom subtalar arthritis is evident.
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Vossen JA, Abbassi M, Qian Y, Hayes CW, Haar PJ, Hoover KB. Correlation between the accessory anterolateral talar facet, bone marrow edema, and tarsal coalitions. Skeletal Radiol 2020; 49:699-705. [PMID: 31781788 DOI: 10.1007/s00256-019-03335-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 10/16/2019] [Accepted: 10/28/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The purposes of this study was to determine the prevalence of the accessory anterolateral talar facet (AALTF); to evaluate the relationship between AALTF, focal abutting bone marrow edema (FABME), and sinus tarsi edema; and to study the prevalence of tarsal coalitions in patients with the AALTF utilizing ankle MR images. MATERIALS AND METHODS 5-T ankle MR images were reviewed for the presence of AALTF, FABME, sinus tarsi edema, tarsal coalition, and location and type of coalition (cartilaginous, fibrous, and osseous). Multivariate analysis was performed to examine the correlation between AALTF and the other variables. RESULTS Three hundred ninety-one consecutive patients were included (age range 5-86 years; mean age 45 years). An AALTF was present in 3.6% (14/391) of patients. The AALTF prevalence was 2% in women and 6.6% in men. There was a significantly association between AALTF and FABME (9/14, p < 0.05), sinus tarsi edema (13/14, p < 0.05), and tarsal coalition (4/14, p < 0.05). CONCLUSION AALTF is relatively often detected on MRI of the ankle and significantly associated with BME, sinus tarsi edema, and subtalar coalition. Patients with a tarsal coalition should be evaluated for the concurrent presence of an AALTF.
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Affiliation(s)
- Josephina A Vossen
- Department of Radiology; Division of Musculoskeletal Imaging and Intervention, Virginia Commonwealth University Medical Center, 1250 E Marshall St, Richmond, VA, 23298, USA.
| | - Mashya Abbassi
- Department of Radiology, Boston University School of Medicine, 820 Harrison Avenue, Boston, MA, 02118, USA
| | - Yanjun Qian
- Department of Statistical Sciences and Operations Research, Virginia Commonwealth University, 1015 Floyd Avenue, Richmond, VA, 23284, USA
| | - Curtis W Hayes
- Department of Radiology; Division of Musculoskeletal Imaging and Intervention, Virginia Commonwealth University Medical Center, 1250 E Marshall St, Richmond, VA, 23298, USA
| | - Peter J Haar
- Department of Radiology; Division of Musculoskeletal Imaging and Intervention, Virginia Commonwealth University Medical Center, 1250 E Marshall St, Richmond, VA, 23298, USA
| | - Kevin B Hoover
- Department of Radiology; Division of Musculoskeletal Imaging and Intervention, Virginia Commonwealth University Medical Center, 1250 E Marshall St, Richmond, VA, 23298, USA
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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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Yildiz KI, Misir A, Kizkapan TB, Keskin A, Akbulut D. Functional and Radiological Outcomes After Tarsal Coalition Resections: A Minimum 5-Year Follow-Up. J Foot Ankle Surg 2019; 58:1223-1228. [PMID: 31679676 DOI: 10.1053/j.jfas.2018.12.040] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 12/08/2018] [Accepted: 12/11/2018] [Indexed: 02/03/2023]
Abstract
Few studies have evaluated the long-term functional and radiological outcomes of tarsal coalition resections. This study aimed to report and compare the functional and radiological outcomes after talocalcaneal (TC) and calcaneonavicular (CN) coalition resections. Thirty-three patients between 12 and 35 years old with symptomatic tarsal coalitions participated, each undergoing tarsal coalition resections (24 TC and 9 CN). The range of motion, visual analog scale score, American Orthopedic Foot and Ankle Society hindfoot scale, Maryland foot score, tripod index, and modified Kellgren-Lawrence scale for subtalar osteoarthritis were used to evaluate the functional and radiological outcomes. The mean age at the time of surgery and mean follow-up in the TC group were 17.8 ± 5.6 years (range 13 to 35) and 6.2 ± 1.7 years (range 5 to 12), respectively, and 16.0 ± 4.4 years (range 12 to 23) and 7.7 ± 3.0 years (range, 5 to 12) in the CN group. There was no difference in the range of motion, outcome scores, tripod index score, and modified Kellgren-Lawrence scale score between patients in the 2 groups. A positive correlation was noted between the size of the TC coalition, coalition/joint surface ratio, and hindfoot valgus angle regarding outcome scores. However, there was no association between the modified Kellgren-Lawrence scale score and outcome scores. At the minimum 5-year follow-up, the functional and radiological outcomes were similar between TC and CN resections. Subtalar joint osteoarthritis developed in all patients with TC resections and most patients with CN resections, but patients did not have functional impairment.
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Affiliation(s)
- Kadir Ilker Yildiz
- Suregeon, Baltalimani Bone and Joint Diseases Training and Research Hospital, Istanbul, Turkey.
| | - Abdulhamit Misir
- Surgeon, Sanliurfa Training and Research Hospital, Sanliurfa, Turkey
| | - Turan Bilge Kizkapan
- Suregeon, Baltalimani Bone and Joint Diseases Training and Research Hospital, Istanbul, Turkey
| | - Abdi Keskin
- Surgeon, Nizip State Hospital, Gaziantep, Turkey
| | - Deniz Akbulut
- Surgeon, Bitlis Tatvan State Hospital, Bitlis, Turkey
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30
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Sobrón FB, Benjumea A, Alonso MB, Parra G, Pérez-Mañanes R, Vaquero J. 3D Printing Surgical Guide for Talocalcaneal Coalition Resection: Technique Tip. Foot Ankle Int 2019; 40:727-732. [PMID: 30808181 DOI: 10.1177/1071100719833665] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
| | - Antonio Benjumea
- 1 Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Guillermo Parra
- 1 Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Javier Vaquero
- 1 Hospital General Universitario Gregorio Marañón, Madrid, Spain
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31
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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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32
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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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34
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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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Abstract
INTRODUCTION Recommendations for the initial treatment (nonoperative measures to surgical excision) of symptomatic tarsal coalitions vary. Because nonoperative outcomes are poorly established, we retrospectively evaluated their success in preventing surgery and achieving pain relief for pediatric patients with symptomatic tarsal coalitions. MATERIALS AND METHODS A retrospective study of pediatric patients with symptomatic tarsal coalitions treated at a single institution was undertaken. Clinical notes were examined for treatment methods, response to treatment, and need for additional procedures. A statistical analysis was performed using the chi-square and Mann-Whitney U tests. RESULTS Fifty symptomatic tarsal coalitions (mean patient age, 11.4 years; range, 8.1-17.9) were treated with nonoperative measures. Surgery was not required in 79% of calcaneonavicular and 62% of talocalcaneal coalitions. Pain relief was achieved in 53% of 81 nonoperative treatment trials. Continuous immobilization via casting, intermittent immobilization via walking boot, and supportive measures were not significantly different in pain relief (p = 0.35) or preventing surgery (p = 0.62). CONCLUSION Nonoperative treatment methods have the potential to achieve pain relief and prevent or delay surgery for symptomatic tarsal coalitions. However, some families may elect to forgo nonoperative measures knowing that surgery may eventually be required.
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Affiliation(s)
| | - Radu Gheorghe
- Orthopaedics, The Hughston Clinic, Jacksonville, USA
| | - Kevin M Neal
- Orthopaedics, Nemours Children's Hospital, Jacksonville , USA
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36
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Abstract
MR imaging has an important role in the evaluation of the postoperative foot and ankle. In this article, a variety of operative techniques and postoperative findings in the foot and ankle are described, including tendon and ligament reconstruction, as well as the treatment of tarsal coalition and Morton neuroma. The role of MR imaging in the assessment of complications of foot and ankle surgery is also detailed.
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Affiliation(s)
- Samuel D Madoff
- Department of Radiology, New England Baptist Hospital, Tufts University School of Medicine, 125 Parker Hill Avenue, Boston, MA 02120, USA.
| | - Jeffrey Kaye
- Department of Radiology, New England Baptist Hospital, Tufts University School of Medicine, 125 Parker Hill Avenue, Boston, MA 02120, USA
| | - Joel S Newman
- Department of Radiology, New England Baptist Hospital, Tufts University School of Medicine, 125 Parker Hill Avenue, Boston, MA 02120, USA
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Upadhyay B, Mo J, Beadsmoore C, Marshall T, Toms A, Buscombe J. Technetium-99m Methylene Diphosphonate Single-photon Emission Computed Tomography/Computed Tomography of the Foot and Ankle. World J Nucl Med 2017; 16:88-100. [PMID: 28553174 PMCID: PMC5436330 DOI: 10.4103/1450-1147.203077] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
The complex anatomy and function of the foot and ankle can make it difficult to determine the cause of symptoms in patients with foot and ankle pathology. Following initial clinical and radiographic assessment, additional imaging with magnetic resonance imaging may be required, which is often seen as the modality of choice. Although sensitive to pathological changes in bone metabolism and vascularity, technetium-99m (Tc-99m) bone scintigraphy often lacks the specificity and resolution required to evaluate the structures of the foot and ankle. Tc-99m methylene diphosphonate single-photon emission computed tomography/computed tomography (SPECT/CT) combines this sensitivity with the superior anatomical detail of CT, enabling better localization of pathological uptake and evaluation of associated structural changes. As a result, SPECT/CT has been growing in popularity for the assessment of patients with foot and ankle pathology where it can provide additional information that may change the initial diagnosis and subsequent management plan. Studies have reported modification of the surgical approach and site of intra-articular local anesthetic injections following SPECT/CT with good results. Interpretation of SPECT/CT studies requires an understanding of the pathological changes that result in increased tracer accumulation in addition to the CT changes that may be seen. This review aims to highlight the advantages of SPECT/CT, potential applications and explain the imaging appearances of common pathologies that may be observed.
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Affiliation(s)
- Bhavin Upadhyay
- Department of Radiology, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, UK
| | - Jonathan Mo
- Department of Radiology, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, UK
| | - Clare Beadsmoore
- Department of Radiology, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, UK
| | - Tom Marshall
- Department of Radiology, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, UK
| | - Andoni Toms
- Department of Radiology, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, UK
| | - John Buscombe
- Department of Nuclear Medicine, Cambridge University Hospitals, Cambridge, UK
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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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39
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Abstract
BACKGROUND Verifying the exact location of talocalcaneal (TC) coalition is important for surgery, but the complicated anatomy of the subtalar joint makes it difficult to visualize on radiographs. No study has used computed tomography (CT) or magnetic resonance imaging (MRI) to verify the radiological characteristics of TC coalition or those of different facet coalitions. Therefore, this study verified the radiological findings used to identify TC coalitions and those of different facet coalitions using CT and MRI. MATERIALS AND METHODS Plain with/without weight bearing anteroposterior and lateral radiographs, CT, and MRI of 43 feet in 39 patients with TC coalitions were reviewed retrospectively. CT or MRI was used to verify the location of the TC coalition. Secondary signs for the presence of a coalition in the anteroposterior and lateral plain radiographs, including talar beak, humpback sign, duck-face sign, and typical or deformed C-sign, were evaluated. Three independent observers evaluated the radiographs twice at 6-week intervals to determine intraobserver reliability. They examined the radiographs for the secondary signs, listed above, and coalition involved facets. RESULTS The average rates from both assessments were as follows: Middle facet 5%, middle and posterior facets 27%, and posterior facet 68%. The deformed C-sign is more prevalent in posterior facet coalitions. The posterior facet has the highest prevalence of involvement in TC coalitions, and the deformed C-sign and duck-face sign have high correlations with TC coalitions in the posterior subtalar facet. CONCLUSION A posterior facet is the most prevalent for TC coalition, and the C-sign is useful for determining all types of TC coalition.
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Affiliation(s)
- Soon Hyuck Lee
- Department of Orthopedic Surgery, College of Medicine, Korea University Anam Hospital, 126-1, Anam-dong 5 ga, Seongbuk-gu, Seoul, Republic of Korea
| | - Hyung Jun Park
- Department of Orthopedic Surgery, College of Medicine, Korea University Anam Hospital, 126-1, Anam-dong 5 ga, Seongbuk-gu, Seoul, Republic of Korea
| | - Eui Dong Yeo
- Department of Orthopaedic Surgery, Veterans Health Service Medical Center, 53, Jinhawngdo-ro 61 gil, Gangdong-gu, Seoul 134-791, Republic of Korea
| | - Young Koo Lee
- Department of Orthopedic Surgery, College of Medicine, Soonchunhyang University Bucheon Hospital, 1174 Jung-1-dong, Wonmi-gu, Bucheon-si, Gyunggi-do 420-767, Republic of Korea,Address for correspondence: Dr. Young Koo Lee, Department of Orthopedic Surgery, College of Medicine, Soonchunhyang University Bucheon Hospital, 1174 Jung-1-dong, Wonmi-gu, Bucheon-si, Gyunggi-do 420-767, Republic of Korea. E-mail:
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40
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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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41
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Paul J, Barg A, Kretzschmar M, Pagenstert G, Studler U, Hügle T, Wegner NJ, Valderrabano V, Geurts J. Increased Osseous (99m)Tc-DPD Uptake in End-Stage Ankle Osteoarthritis: Correlation Between SPECT-CT Imaging and Histologic Findings. Foot Ankle Int 2015; 36:1438-47. [PMID: 26231199 DOI: 10.1177/1071100715596745] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND We analyzed the histopathologic findings in end-stage osteoarthritic ankle joint tissue that display increased uptake of bone-seeking radiotracer in single-photon emission computed tomography-computed tomography (SPECT-CT) imaging. METHODS Six consecutive patients with end-stage osteoarthritis undergoing total ankle replacement received preoperative SPECT-CT imaging using (99m)Technetium dicarboxypropane diphosphonate ((99m)Tc-DPD). Using imaging data for stratification, osteochondral tissue sections were prepared from SPECT-positive (+) and -negative (-) areas of tibial and talar resection specimens. Histomorphometric analyses of osteoblast numbers, collagen deposition, and cartilage degeneration were performed on hematoxylin and eosin, van Gieson's and Safranin-O stained tissue sections. Osteoclast activity was visualized using tartrate-resistant acid phosphatase (TRAP) staining. RESULTS Increased (99m)Tc-DPD uptake was observed exclusively subjacent to the subchondral bone plate of tibial and talar joint compartments. SPECT(-) tissues displayed typical fatty marrow morphology containing mainly collagen-positive blood vessels and few marrow and bone-lining cells. SPECT(+) tissues were characterized by increased numbers of active bone-lining osteoblasts depositing collagen fibers. Collagen area fraction of subchondral bone marrow was significantly increased in SPECT(+) (0.52 ± 0.21) compared with SPECT(-) (0.29 ± 0.13) tissues (P = .30). Multinucleated TRAP(+) osteoclasts were absent from bone formation sites, but associated with vascular structures invading articular cartilage through the subchondral bone plate. Increased (99m)Tc-DPD uptake was specifically and strongly correlated with increased osteoblast numbers (P = .011), and with collagen area fraction (P = .030) but not with Mankin score (P = .202), or with osteoclast number (P = .576). CONCLUSION Subchondral bone tissues in SPECT(+) areas of end-stage ankle osteoarthritis were histologically characterized by increased osteoblast-mediated bone formation in the absence of functional osteoclasts, and increased cellularity and collagen deposition in marrow tissues. CLINICAL SIGNIFICANCE Our findings suggest a pathologic bone-remodeling process in end-stage ankle OA areas with increased (99m)Tc-DPD uptake.
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Affiliation(s)
- Jochen Paul
- Praxisklinik Rennbahn AG, Basel, Switzerland
| | | | | | | | - Ueli Studler
- University Hospital of Basel, Basel, Switzerland
| | - Thomas Hügle
- University Hospital of Basel, Basel, Switzerland
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42
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Kamiya T, Watanabe K, Teramoto A, Yamashita T. Cuboid-Navicular Tarsal Coalition in an Adolescent Female Athlete: A Case Report. JBJS Case Connect 2015; 5:e93. [PMID: 29252799 DOI: 10.2106/jbjs.cc.o.00002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE A fourteen-year-old female shot-putter developed midfoot pain with activity that initially responded to nonoperative care. However, the symptoms subsequently returned and became persistent. Advanced imaging demonstrated a fibrous cuboid-navicular tarsal coalition. Surgical resection of the tarsal coalition was performed when the patient was seventeen years old, and she returned to sports activities postoperatively with no pain. CONCLUSION Although fibrous cuboid-navicular tarsal coalition is a very rare condition, it should be considered as one cause of persistent midfoot pain in an adolescent athlete. Surgical resection of the tarsal coalition can lead to a resolution of symptoms.
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Affiliation(s)
- Tomoaki Kamiya
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, South 1, West 16 Chu-o-ku, Sapporo, Japan 060-8543
| | - Kota Watanabe
- Department of Physical Therapy, Sapporo Medical University School of Health Sciences, South 1, West 17 Chu-o-ku, Sapporo, Japan 060-8556
| | - Atsushi Teramoto
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, South 1, West 16 Chu-o-ku, Sapporo, Japan 060-8543
| | - Toshihiko Yamashita
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, South 1, West 16 Chu-o-ku, Sapporo, Japan 060-8543
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43
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Reddy Mettu R, Koduru SK, Surath H, Surath A. Total Bilateral Tarsal Coalition: A Case Report. J Foot Ankle Surg 2015; 55:1035-7. [PMID: 26277240 DOI: 10.1053/j.jfas.2015.06.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Indexed: 02/03/2023]
Abstract
A 35-year-old male presented with pain and swelling of his right foot and ankle. His pain developed gradually and without overt pedal deformity. The radiologic examination revealed complete fusion of all tarsal bones of his right foot. Comparative radiographs of his left foot also showed complete tarsal coalition. Ankle osteoarthritis was diagnosed, and supportive treatment enabled the patient to return to an asymptomatic status and continue the duties of his employment. This case is presented to describe an adult patient with bilateral, massive tarsal coalition who was essentially asymptomatic until degenerative arthritic changes developed in one of his ankles.
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Affiliation(s)
- Rami Reddy Mettu
- Assistant Professor, Department of Orthopaedics, NRI Medical College and General Hospital, Guntur, India
| | - Satya Kumar Koduru
- Professor, Department of Orthopaedics, NRI Medical College and General Hospital, Guntur, India
| | - Harshavardhan Surath
- Resident, Department of Orthopaedics, NRI Medical College and General Hospital, Guntur, India
| | - Amarnath Surath
- Professor, Department of Orthopaedics, NRI Medical College and General Hospital, Guntur, India.
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44
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Abstract
Tarsal coalitions, while relatively uncommon, are typically identified in adult patients during an evaluation for ankle instability, sinus tarsus pain, and/or pes planovalgus. The true incidence of tarsal coalition is unknown with estimates ranging from 1% to 12% of the overall population. The most common area of involvement of the subtalar joint is the middle facet, and heightened awareness should be present in adult patients with limited motion of the subtalar joint. Standard radiographic imaging, to include a Harris heel view, is recommended initially, although computerized tomography scan and MRI are often necessary to confirm the diagnosis.
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45
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Krief E, Ferraz L, Appy-Fedida B, Deroussen F, Plancq MC, Collet LM, Gouron R. Tarsal Coalitions: Preliminary Results After Operative Excision and Silicone Sheet Interposition in Children. J Foot Ankle Surg 2015; 55:1264-1270. [PMID: 25990535 DOI: 10.1053/j.jfas.2015.03.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Revised: 01/22/2015] [Accepted: 03/19/2015] [Indexed: 02/03/2023]
Abstract
Symptomatic tarsal coalitions that begin in early adolescence are usually treated by resection and interposition (fat, muscle, or bone wax) to prevent recurrence. The purpose of the present retrospective study was to describe our operative technique and report our clinical and radiologic outcomes with sterile silicone sheet interposition after resection of painful tarsal coalitions in 4 children (4 feet). The present series included 1 case of talocalcaneal synchondrosis and 3 of synostosis (2 talocalcaneal and 1 cuboid-navicular). Two validated functional scales were used to assess the patients' overall outcome and satisfaction with the procedure: the American Orthopaedic Foot and Ankle Society ankle-hindfoot score and the Foot Function Index. Conventional radiography, computed tomography with 3-dimensional reconstruction, and magnetic resonance imaging were performed at the final follow-up visit. The mean follow-up period was 40 (range 12 to 80) months. The mean age at surgery was 10.5 (range 8 to 13) years. All patients had achieved their desired activity level at 6 months postoperatively. The mean American Orthopaedic Foot and Ankle Society ankle-hindfoot score was 93.5 (range 74 to 100), and the mean Foot Function Index was 3.25% (range 0% to 13%). No recurrence of the coalition on imaging at the final follow-up visit was observed in this patient series. Sterile silicone sheet interposition can be used to prevent recurrence of tarsal coalition in symptomatic tarsal coalitions after failure of conservative management.
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Affiliation(s)
- Elie Krief
- Surgeon, Department of Pediatric Orthopaedic Surgery, Amiens University Hospital and Jules Verne University of Picardy, Amiens, France
| | - Linda Ferraz
- Surgeon, Department of Pediatric Orthopaedic Surgery, Amiens University Hospital and Jules Verne University of Picardy, Amiens, France
| | - Benjamin Appy-Fedida
- Surgeon, Department of Pediatric Orthopaedic Surgery, Amiens University Hospital and Jules Verne University of Picardy, Amiens, France
| | - François Deroussen
- Surgeon, Department of Pediatric Orthopaedic Surgery, Amiens University Hospital and Jules Verne University of Picardy, Amiens, France
| | - Marie-Christine Plancq
- Surgeon, Department of Pediatric Orthopaedic Surgery, Amiens University Hospital and Jules Verne University of Picardy, Amiens, France
| | - Louis-Michel Collet
- Professor, Department of Pediatric Orthopaedic Surgery, Amiens University Hospital and Jules Verne University of Picardy, Amiens, France
| | - Richard Gouron
- Professor, Department of Pediatric Orthopaedic Surgery, Amiens University Hospital and Jules Verne University of Picardy, Amiens, France.
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46
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Merchant R, Bhatt N, Merchant M. Surgical Considerations for Massive Tarsal Coalitions in Multiple Synostosis Syndrome: A Case Report. J Foot Ankle Surg 2015; 54:1162-5. [PMID: 25799911 DOI: 10.1053/j.jfas.2014.12.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Indexed: 02/03/2023]
Abstract
Tarsal-carpal coalition syndrome is an autosomal dominant inherited condition characterized by fusion of the carpal and tarsal bones and foot deformity. Associated pain and/or gait disturbance are the main complaints. The deformity usually consists of varying degrees of hindfoot varus and forefoot supination. The treatment of these patients is mainly aimed at symptomatic relief. We performed a published data review of this condition and discuss our findings in the context of the case of a 10-year-old female with congenital varus deformity of both feet. The tarsal-carpal coalition syndrome has been included in the spectrum of heritable disorders related to mutations in the NOG gene. Deformity management should be customized to the patient's requirements, and satisfactory results are achievable with adequate rehabilitation. It is important to remember that surgery is only necessary for symptomatic relief and that patients with tarsal-carpal coalition syndrome should be followed up over time because the condition can evolve.
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Affiliation(s)
- Rajiv Merchant
- Registrar, Waterford Regional Hospital, Waterford, Ireland.
| | - Nikita Bhatt
- Medical Officer, Shubheccha Multispeciality Hospital, Baroda, India
| | - Mrugank Merchant
- Consultant Orthopedic Surgeon, Shubheccha Multispeciality Hospital, Baroda, India
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47
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Abstract
Excision of symptomatic tarsal coalitions, after failure of attempted conservative treatment, is a widely accepted surgical procedure, when the surrounding joints are not degenerated. Historically, the literature has supported open resection. Recently, arthroscopic/endoscopic resection has been described for both calcaneonavicular (CNC) and talocalcaneal (TCC) coalitions. This article describes indications, preoperative planning, surgical techniques, and results of arthroscopic/endoscopic CNC and TCC resection.
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Affiliation(s)
- Davide Edoardo Bonasia
- Department of Orthopaedics and Traumatology, AO Città della Salute e della Scienza - Presidio CTO, University of Torino, Via Zuretti 29, Torino 10100, Italy.
| | - Phinit Phisitkul
- Department of Orthopaedics and Rehabilitation, University of Iowa Hospitals and Clinics, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242, USA
| | - Annunziato Amendola
- Department of Orthopaedics and Rehabilitation, University of Iowa Hospitals and Clinics, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242, USA
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48
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Abstract
There are multiple causes of pediatric foot and ankle pain. Although conservative measures are appropriate for initial management, patients with refractory pain should be given consideration for further intervention. This review highlights some of the most common causes of foot and ankle pain in the child, with specific attention to demographics, etiologies, diagnostic workup, and treatment options.
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Affiliation(s)
- Amiethab Aiyer
- Department of Orthopaedic Surgery, Penn State College of Medicine, 30 Hope Drive, Hershey, PA 17033, USA
| | - William Hennrikus
- Department of Orthopaedic Surgery, Penn State College of Medicine, 30 Hope Drive, Hershey, PA 17033, 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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50
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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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