Peroneal Spastic Flatfoot Research Articles

Surgical Management and Outcomes of Patients with Idiopathic Peroneal Spastic Flatfoot: A Retrospective Case Series.

Although tarsal coalition represents the most common cause of peroneal spastic flatfoot, its existence cannot be verified in several cases. In some patients with rigid flatfoot, no cause can be detected after clinical, laboratory, and radiologic examination, and the condition is called idiopathic peroneal spastic flatfoot (IPSF). This study aimed to present our experience with surgical management and outcomes in patients with IPSF. Seven patients with IPSF, who were operated on between 2016 and 2019, and followed for at least 12 months were included, whereas those with known causes, such as tarsal coalition or other causes (eg, traumatic) were excluded. All patients were followed up for 3 months with botulinum toxin injection and cast immobilization as a routine protocol, and clinical improvement was not achieved. The Evans procedure and grafting with tricortical iliac crest bone graft in five patients and subtalar arthrodesis in two patients were performed. The American Orthopaedic Foot and Ankle Society ankle-hindfoot scale scores and Foot and Ankle Disability Index scores were obtained preoperatively and postoperatively from all patients. On physical examination, all feet manifested rigid pes planus with varying degrees of hindfoot valgus and limited subtalar motion. Overall, the mean American Orthopaedic Foot and Ankle Society and Foot and Ankle Disability Index scores significantly increased from 42 (range, 20-76) and 45 (range, 19-68) preoperatively (P = .018) to 85 (range, 67-97) and 84 (range, 67-99) (P = .043) at the final follow-up, respectively. No major intraoperative or postoperative complications were observed in any of the patients. All computed tomographic and magnetic resonance imaging scans revealed no evidence of tarsal coalitions in any of the feet. All radiologic workups failed to demonstrate secondary signs of fibrous or cartilaginous coalitions. Operative treatment seems to be a good option in the treatment of patients with IPSF who do not benefit from conservative treatment. In the future, it is recommended to investigate the ideal treatment options for this group of patients.

Evaluation and Management of Adolescents With a Stiff Flatfoot.

While flatfeet are normal in children, persistence into adolescence with associated pain or asymmetry warrants additional evaluation. Rigidity of a flatfoot deformity, whether a clinical report or evident on examination, should raise suspicion for pathology. The differential diagnosis includes tarsal coalition, neurogenic planovalgus, and peroneal spasticity. History must include pointed inquiry into birth and neurologic histories to probe for a source of central spasticity. Examination must include standing assessment of hindfoot and midfoot alignment. Hindfoot rigidity may be assessed by the double limb heel rise test and manual examination. Radiographs should include standing ankle (anterior-posterior and mortise) and whole foot (anterior-posterior, external rotation oblique, and lateral) images. Magnetic resonance imaging is more sensitive for identifying coalitions and better characterizes adjacent cartilage, subchondral edema, and tendon pathology, yet CT better characterizes the anatomy of a bony coalition. Conservative treatments are pathology-dependent and play a more prominent role in neurogenic or peroneal spastic flatfoot. Surgical management of coalitions is centered on coalition resection coupled with arthrodesis in the case of a talocalcaneal coalition with a dysplastic subtalar joint; concomitant planovalgus reconstruction is considered on a case-by-case basis.

Diagnosis of tarsal coalitions

Tarsal coalitions (TC) are congenital abnormal connections of the rearfoot bones. They occur in 1 to 13 % of all population. The article deals with the features of clinical and instrumental diagnosis of TC according to the literature. The main clinical manifestations are pain syndrome in the subtalar area, rigid flat foot; peroneal spastic flat foot is possible. Radiographic imaging of TC includes direct and indirect signs. To verify bone coalition, computed tomo-graphy is indicated, in cases of cartilaginous and fibrous — magnetic resonance imaging. Despite the long history of studying the problem, the diagnosis of TC remains a live issue today. Difficulties in diagnosing this pathology are due to the lack of physicians’ awareness of the clinical and radiographic picture of TC. Classical orthopedic exa-mination and suspicion of possible TC will allow detecting pathology in time and avoiding inappropriate treatment. The use of modern imaging techniques, such as computed tomography and magnetic resonance imaging, helps increase the accuracy of TC diagnosis.

Staged surgical management of sinus tarsi syndrome: our experience of 273 cases.

The sinus tarsi syndrome (STS) is a common foot and ankle disease with controversial pathogenesis and treatment procedures. This long-term study aimed to analyze the effect of a staged surgical strategy for STS. Clinical data were retrospectively analyzed in 273 STS patients [129 men and 144 women; mean age: 36 years (10-60 years)] treated between 2006 and 2016. The 89 patients underwent different surgeries, including sinus tarsal debridement, subtalar joint stabilization, sinus tarsal denervation, tarsal coalition resection, or subtalar arthrodesis. The patients' American Orthopedic Foot & Ankle Society (AOFAS) ankle-hindfoot scores, visual analogue scale (VAS) scores for pain during daily activities, and 36-item short-form health survey (SF-36) scores at the first visit and latest follow-up were assessed by paired T-test. The 89 patients who failed conservative treatments first underwent tarsal sinus soft tissue debridement, with 52 patients remaining in remission after 2 years. The other 37 patients with relapse underwent further surgeries. Five of the 19 patients with subtalar instability were cured following ligament reconstruction surgery. Two of the four patients with severe neurological signs recovered after nerve release surgery. Five of the 10 patients with tarsal coalition were cured by resection of the talocalcaneal bridge. A total of 21 patients failed their second operations due to peroneal spasm, and were eventually successfully treated by subtalar arthrodesis. In addition, subtalar arthrodesis was directly performed in the remaining four patients with peroneal spastic flatfoot. After the final operations, all patients achieved satisfactory results. The AOFAS ankle-hindfoot scores increased from 34.83±12.21 preoperatively to 85.52±7.07 postoperatively (t=-24.62, P<0.01), the VAS scores decreased from 8.14±1.52 to 2.14±1.00 (t=24.65, P<0.01), and the SF-36 scores increased from 36.58±11.36 to 86.22±9.17 (t=-28.13, P<0.01). In this study, we observed that 67% (184/273) of patients with STS need a staged surgical management. According to the etiology, symptoms, and severity, soft tissue surgery is the first choice. However, simple soft tissue surgeries may fail to achieve long-term results. Once the symptoms recur and become difficult to cure, the staged surgical strategy for STS we proposed can be the best choice to achieve long-term results.

腓骨筋痙性扁平足に対しaccessory anterolateral talar facet切除術が著効した1例

腓骨筋痙性扁平足に対しaccessory anterolateral talar facet切除術が著効した1例

Peroneal spastic flatfoot in adolescents with accessory talar facet impingement: a preliminary report.

This study analyzed imaging, arthroscopic findings, and treatment responses for peroneal spastic flatfoot (PSFF) caused by talocalcaneal impingement at the accessory anterolateral talar facet (AALTF) (accessory talar facet impingement) in 13 adolescents without histories of trauma and tarsal coalition. The AALTF was determined with computed tomography and MRI. Focal abutting bone marrow edema (FABME) on MRI around the AALTF was confirmed. In seven patients who underwent AALTF resection, subtalar arthroscopy was performed. All experienced alleviation PSFF after treatment; reduction in FABME was observed. AALTF resection alone is beneficial for PSFF caused by accessory talar facet impingement when peroneal spasms are restored by an injection of local anesthesia.

Tibialis Spastic Varus Foot With Calcaneonavicular Coalition

Peroneal spastic flat foot is a well-known condition usually occurring with tarsal coalition. Conversely, tibialis spastic varus foot is a rare condition, which can be difficult to diagnose. Moreover, tibialis spastic varus foot with calcaneonavicular coalition is extremely rare, with only a few published case reports. Resection of the calcaneonavicular bar is performed in the majority of patients. We report a case of tibialis spastic varus foot with calcaneonavicular coalition in an 11-year-old boy with intellectual disability. His family noticed his right varus foot deformity 1.5 years earlier. There was no obvious history of trauma. The deformity gradually worsened with running. Because conservative treatment failed, resection of the coalition was performed that facilitated a good outcome. In this article, we report our experience of tibialis spastic varus foot with calcaneonavicular coalition and review the English literature of this condition. Therapeutic, Level IV: Case report.

A Clinical Study of Peroneal Spastic Flatfoot in Adults

A Clinical Study of Peroneal Spastic Flatfoot in Adults

Tibialis Spastic Varus Foot With Tarsal Coalition: A Report of Five Cases

Peroneal spastic flat foot (PSFF) is a well-known condition usually occurring with anomalies of tarsal coalition. On the contrary, tibialis spastic varus foot (TSVF) is an extremely rare clinical condition, which can be difficult to diagnose and treat. In 1956, Maudsley [1] reported a case of spastic pes varus with a calcaneonavicular bar. In 1965, Simmons [2] first reported three cases under the name of TSVF. Up to now, 16 patients with TSVF have been reported, and most of these cases were associated with tarsal coalition. The purpose of this article is to report two cases of TSVF without tarsal coalition and to extrapolate the cause and treatment of this condition. The patients and/or their families were informed that data from the case would be submitted for publication and gave their consent.

Peroneal Spastic Flatfoot Caused by a Talar Osteochondral Lesion: A Case Report

Peroneal Spastic Flatfoot Caused by a Talar Osteochondral Lesion: A Case Report

Arthroscopic Resection of the Calcaneonavicular Coalition or the “Too Long” Anterior Process of the Calcaneus

Calcaneonavicular coalition and the “too long” anterior process (TLAP) of the calcaneus can manifest as lateral foot pain, peroneal spastic flatfoot, and repeated ankle sprain. Surgical resection of the bone bar is frequently required. We present here an arthroscopic approach that can be used to accurately assess pathoanatomy and resect the bone bar. A portal is established slightly dorsal to the angle of Gissane. This is the primary visualization portal. The working portal, which is identified under an image intensifier, is located at the space between the talonavicular and calcaneocuboid joints, directly over the TLAP or the calcaneonavicular coalition. With the 2.7-mm 30° arthroscope placed at the primary visualization portal, soft tissue around the TLAP or the calcaneonavicular coalition is cleared up with the use of an arthroscopic shaver at the working portal. After the TLAP or the calcaneonavicular coalition is clearly visualized, it can be resected with an arthroscopic burr through the working portal. The bone bar is resected proximally until the medial side of the calcaneocuboid joint, the lateral side of the taloavicular joint, and the plantar-lateral aspect of the talar head are clearly seen. Inversion stress should then be applied to the foot to prevent further impingement of the anteromedial process of the calcaneus to the plantar-lateral part of the talar head.

Operative treatment of flatfoot with talocalcaneal coalition.

Rigid flatfoot or peroneal spastic flatfoot often is associated with a congenital fibrous, cartilaginous, or osseous union of two tarsal bones or more, potentially causing great difficulties in its treatment. Since 1996, 12 patients (14 feet) with painful flatfoot and restricted motion of the hindfoot attributable to talocalcaneal coalition, were treated by resection of the coalition and subtalar arthroereisis by a bioreabsorbable implant. The results were evaluated by the ankle hindfoot clinical rating system of the American Orthopaedic Foot and Ankle Society. These clinical results also were evaluated statistically. Radiographs and computed tomography scans were taken preoperatively and postoperatively. Eight (57.1% of patients) had excellent results, three (21.4% of patients) had good results, and three (21.4% of patients) had fair results. No poor results, or subjective or objective complications were reported. On the basis of these early results, arthroereisis by implanting a bioreabsorbable device after removal of the tarsal coalition, seems to be an effective procedure for the treatment of symptomatic flatfoot associated with talocalcaneal coalitions: correcting the relationship between talus and calcaneus, restoring the alignment of the hindfoot, and reducing pain.

Tarsal coalition.

Tarsal coalition is a common abnormality of the hindfoot skeleton that only rarely leads to symptoms. These symptoms occur most commonly in adolescence but rarely can be found also in adults. Although most coalitions are congenital, as the consequence of autosomal dominant inheritance, coalitions also can be acquired by degenerative joint disease, inflammatory arthritis, infection, and clubfoot deformities. Fifty percent of all coalitions are bilateral. Talocalcaneal and calcaneonavicular coalitions are most commonly found, and patients frequently have more than one coalition in the same foot. Clinical symptoms of the tarsal coalition frequently follow a sequence of sprains or other minor injuries to the involved foot. This leads to a rigid, painful foot. The pain is worsened by continued activities. The frequently cited peroneal spastic flatfoot is an uncommon means of identifying a tarsal coalition. The diagnosis of the tarsal coalition is made on the oblique radiograph of the foot, which demonstrates the calcaneonavicular coalition. Computed tomography (CT) and magnetic resonance imaging scans show the presence and extent of other coalitions. Secondary signs for the presence of a coalition are talar beaking, anteater nose sign, and C sign. These secondary signs can be demonstrated best on a lateral view of the involved foot. Local anesthetic blocks under image intensifier or CT guidance can identify areas of joint degeneration, which are caused by the altered biomechanics of the foot. Initial treatment should consist of conservative therapy in the form of support or immobilization of the involved foot, change in the activities of the patient, and nonsteroidal anti-inflammatory medication. Surgical treatment in the form of a resection of the coalition should be reserved for those patients for whom conservative therapy has failed. Subtalar or triple arthrodesis should be reserved for those patients for whom all other therapy has failed.

有痛性外けい骨に起因するひ骨筋れん縮性へん平足の一例

A rare case of peroneal spastic flat foot (P. S. F. F) associated with accessory scaphoid is reported. The patient is an 11 years old boy. His chief complaint was left foot pain and restriction of varus motion. On examination, his left foot had valgus deformity. No valus motion existed due to apparent spasm of the peroneal tendon. Roentgenographic revealed no significant findings except for accessory scaphoid. The symptoms were completely relieved by resection of the accessory scaphoid.

Congenital tarsal synostosis

Tarsal coalition results from the fusion of at least two tarsal bones. The clinical and radiological pictures depend on the anatomic location of the coalition. Calcaneonavicular and talonavicular coalitions are the most frequent features which may result in peroneal spastic flat foot; however they are symptomless in most cases. Tarsal coalitions are usually evident on plain X-ray films using appropriate incidences. In selected cases, partial talocalcaneal coalition requires CT scan or MRI. No treatment is needed for asymptomatic conditions. Painful spastic flat foot must be treated conservatively by limiting sport activity as a first step treatment. In case of persistent symptoms, cast with correction of deformities under general anesthaesia is recommended. Surgery is needed only in case of failure of previous treatment, requiring resection of the bony bridge and sometimes triple foot arthrodesis.

Resection of tarsal coalition

Calcaneonavicular and talocalcaneal bar are the most common types of tarsal coalition, which is the predominant cause of rigid or peroneal spastic flatfoot. The presenting symptoms of frequent sprains, pain around the subtalar joint, loss of varying degrees of the medial arch, and progressive loss of subtalar motion are common to both forms. Roentgenographic diagnosis can be made with the lateral oblique for the calcaneonavicular bar and the posterior oblique for the talocalcaneal bar. Computerized axial tomography (CT) is perhaps the most diagnostic radiologic evaluation for both types. The treatment regimen for both forms is a trial of casting and orthotics; surgery is indicated when conservative therapy fails. Surgical treatment consists of resection with interpositional arthroplasty or arthrodesis, either limited or the triple arthrodesis. Resection with interposition of the extensor digitorum brevis for calcaneonavicular bar is the most accepted surgical treatment. Resection with fat graft for talocalcaneal bars, which occupy less than one half of the subtalar joint with no other degenerative changes, is a newer technique that has favorable results.

The interposition of extensor digitorum brevis in the resection of calcaneonavicular bars.

In this series of 19 resected calcaneonavicular bars for peroneal spastic flatfoot (mean follow-up 3.4 years), we demonstrate that interposition of extensor digitorum brevis led to asymptomatic mobile feet without evidence of recurrence of the bar in 90% of the patients; this compares well with 43% recurrence rates of bars with associated pain and stiffness when extensor digitorum brevis is not interposed. We therefore recommend this method for prevention of the bar and their symptoms.

Dysplasia Epiphysealis Hemimelica (Trevor Disease) Presenting as Peroneal Spastic Flatfoot Deformity: A Case Report

Trevor disease (dysplasia epiphysealis hemimelica) involving the foot and ankle is not uncommon, but its presentation as a progressive spastic flatfoot deformity is unusual. The patient reported had an isolated lesion in the medial facet of the subtalar joint. In addition to the unusual presentation and location, the lesion recurred 1 year after surgical excision.

Association of Slipped Upper Femoral Epiphysis and Peroneal Spastic Flatfoot

A significant association between slipped upper femoral epiphysis (SCFE) and subtalar arthritis causes peroneal spastic flatfoot. Three patients with this association were observed in 136 cases of SCFE, an incidence of 2.3%; the anticipated incidence would be 0.4%. We postulate that both conditions reflect an underlying immunologic disorder.

興味あるけい直性へん平足の一例

A rare case of peroneal spastic flat foot (P. S. F. F.) associated with accessory scaphoid is reported. The patient is a 12 years old boy. His chief complaint was left foot pain.On examination, left foot had valgus deformity. No peritalar motion existed due to apparent spasm of the peroneal and extensor digitorum longus tendons.Roentgenographic and CT examinations revealed no significant findings except for accessory scaphoid. The symptoms were completely relieved by removal of the accessory scaphoid.