Abstract
Subtalar coalition is an uncommon condition that usually manifests in early adolescence(1). Frequently, this condition is missed. Delayed diagnosis may result in osteoarthritis requiring triple arthrodesis. Here, we report two patients with subtalar coalition. The first patient is a 12 year old boy who presented with right ankle pain for one year and was treated with excision of the coalition and bone wax insertion at the excision site. We followed up the patient for two years and the result was excellent with full range of movement of his right ankle and subtalar joint attained within two months. He returned to athletic activity by six months and was discharged with no complications after two years. The second patient is a 15 year old girl who presented with bilateral ankle pain and swelling for three years and was treated with excision of the coalition and subtalar interpositional arthroplasty bilaterally. She defaulted follow up after seven months as she was very satisfied with the result. We wish to highlight this condition which may be misdiagnosed as flexible flat foot or ankle sprain. Subtalar coalition, excision of coalition, bone wax insertion, subtalar interpositional arthroplasty.
Highlights
Talo-calcaneal coalition is an abnormal bridge between the talus and calcaneum, causing hindfoot pain, bony swelling and restriction of subtalar movement
Symptoms usually manifest in early adolescence when the bridge starts to ossify and the diagnosis is made clinically and confirmed with CT scan if osseous fusion, or with MRI if fibrous or cartilaginous fusion .We report two typical cases of subtalar coalition in two adolescents with similar presentations .This case report stresses the importance of clinical suspicion in an adolescent who presents with ankle pain and restricted motion with flat feet
The second patient was a 16-year old girl who presented with bilateral ankle pain and swelling for 4 years .The pain was dull in nature, aggravated by walking, relieved by rest, radiating to the heel and gradually worsening and limiting her daily activities
Summary
Talo-calcaneal coalition is an abnormal bridge between the talus and calcaneum, causing hindfoot pain, bony swelling and restriction of subtalar movement. The abnormal connection can be bony, cartilaginous or fibrous in nature with reported incidence ranging from 1 to 12% 1. Symptoms usually manifest in early adolescence when the bridge starts to ossify and the diagnosis is made clinically and confirmed with CT scan if osseous fusion, or with MRI if fibrous or cartilaginous fusion .We report two typical cases of subtalar coalition in two adolescents with similar presentations .This case report stresses the importance of clinical suspicion in an adolescent who presents with ankle pain and restricted motion with flat feet. A high index of suspicion is required so as not to miss this treatable condition
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