The Presence of Calcaneal Fibular Remodeling Associated With Middle Facet Talocalcaneal Coalition: A Retrospective CT Review of 35 Feet. Investigations Involving Middle Facet Coalitions—Part II

Abstract

Middle facet talocalcaneal coalition is often associated with a rigid pes planovalgus. In the presence of calcaneal valgus, the fibula may come into contact with the lateral calcaneal wall during weight bearing, and develop a pseudoarticulation. Spurring, bone cysts, and other morphologic changes may concomitantly occur at the calcaneus and fibula, suggesting a pathological degenerative process. This association has not been previously studied in middle facet tarsal coalition and we term the condition calcaneal fibular remodeling, the focus of this investigation. To our knowledge, no study has specifically looked at the abutment of the calcaneus and fibula as an additional area of pathology in patients treated operatively for tarsal coalition. Computerized axial tomography was retrospectively reviewed in 21 patients (35 feet) with symptomatic middle facet talocalcaneal coalition who were surgically treated for the coalition on at least 1 foot over a 12-year period. In 19 (54%) of the 35 feet, calcaneal fibular remodeling was identified and associated with concomitant coalition and pes planovalgus deformity. Fifteen (79%) of the 19 feet with calcaneal fibular remodeling were managed surgically at the time of manuscript submission for middle facet talocalcaneal coalition. This new finding suggests that simple resection of the coalition may not fully address the entire deformity and other combined surgical approaches may be more appropriate in the face of middle facet talocalcaneal coalition with heel valgus and calcaneal fibular remodeling.