Evaluation of surgical outcomes of calcaneonavicular coalition and too-long anterior process in children: A prospective study

Abstract

IntroductionCalcaneonavicular coalitions (CC) affect approximately 1% of the general population. CC or Too-long anterior process (TLAP) result in “repeated sprains” that can be associated with foot and/or ankle chronic pain. The main objective of this study was to analyze the effectiveness of surgery using the AOFAS score. HypothesisFunctional results after surgical treatment of CC or TLAP are not as good as expected. Materials and methodsA single-center prospective study was carried out at our University Hospital from 01/01/2019 to 06/01/2021. The patients included were operated on in the pediatric surgery department for CC or TLAP resection by direct approach after MRI confirmation and failure of non-operative treatment. A survey evaluating the AOFAS score as well as the number of ankle sprains and the intensity of pain was undertaken at the preoperative consultation and then at three and twelve months postoperatively. ResultsA total of 17 feet in 16 patients (14 girls and 2 boys) comprising 12 TLAP and 5 CC were included. The AOFAS score was statistically significantly increased (58.6 vs. 82.9; p<0.001) postoperatively. No statistical difference was noted between the follow-up visits at three and twelve months. At the twelve-month follow-up, 9 out of 16 patients (56.2%) still reported activity restrictions; mainly linked to the persistence of chronic pain, and 10 out of 16 patients (62.5%) reported a feeling of instability. DiscussionCC and TLAP surgery rapidly improves function but it does not dramatically reduce foot pain and activity restrictions. A dedicated score would be useful to identify patients who will benefit the most from surgery. Level of evidenceIV; prospective study.