Peroneal Spastic Flatfoot Research Articles

Peroneal spastic flatfoot and tarsal coalitions.

Peroneal spastic flatfoot and tarsal coalitions.

Computerized tomography of talocalcaneal tarsal coalition: a clinical and anatomic study.

Consistently accurate radiographic diagnosis of talocalcaneal tarsal coalitions is difficult because of the complex anatomy of the subtalar articulations. Standard techniques that include special radiographic views and plain tomography are useful but often inconclusive. In this study, computerized tomography (CT) was used to evaluate suspected talocalcaneal coalitions in patients with the clinical diagnosis of peroneal spastic flatfoot. CT demonstrated bony and nonbony coalitions in 14 of 22 patients studied. In the remaining eight patients, CT effectively ruled out the diagnosis of subtalar coalitions. If the coalition is obvious, CT will confirm it; if the clinical syndrome exists but standard radiographic procedures do not document the lesion, CT scan will be helpful in establishing a diagnosis. Anatomic studies of fresh cadaver feet compared CT, plain tomography, and plain radiographs for efficacy in visualizing the three subtalar facet joints. CT was superior to the other modalities for clearly identifying all aspects of the subtalar joint and talocalcaneal coalitions in patients and cadavers.

Tarsal coalition and its relation to peroneal spastic flatfoot.

Tarsal coalition and its relation to peroneal spastic flatfoot.

Tarsal coalitions and peroneal spastic flat foot. A review.

Tarsal coalitions and peroneal spastic flat foot. A review.

The Relative Incidence of Tarsal Coalition

The overall incidence of tarsal coalition in the general population is unknown, but it is far less than 1%. Calcaneonavicular coalition was found to be the most common type (53%), followed by talocalcaneal coalition (37%). The other types appear infrequently. Most calcaneonavicular and talocalcaneal coalitions present as a painful foot of some type. Peroneal spastic flatfoot is a rare finding and occurred in only two of 22 talocalcaneal coalitions in the present study. Talonavicular coalitions were always associated with other congenital foot anomalies and were typically asymptomatic. Age at presentation, sex, and time to diagnosis were not statistically different among patients with coalitions at different locations. It is thought that clinical presentation corresponds to ossification of the coalition, which occurs an average of three to four years later.

Peroneal spastic flat foot. Its treatment by osteotomy of the os calcis.

A series of patients treated by osteotomy of the os calcis for the relief of peroneal spastic flat foot is reviewed. The late results have been evaluated, and the literature reviewed. It is suggested that this is an effective method of treatment which has advantages over tarsal fusions.

Peroneal Spastic Flatfoot Syndrome

Tarsal coalitions are not the sole cause of peroneal spastic flatfoot, and any irritative lesion in the peritalar area can induce protective contraction of any or all of the muscles bridging the peritalar joints. True muscular peroneal spasm has been shown to be present on a clinical basis in this entity where tarsal coalitions are not present. Neoplasm should be included in the differential diagnosis of the rigid flatfoot deformity.

THE INHERITANCE OF TARSAL COALITION AND ITS RELATIONSHIP TO SPASTIC FLAT FOOT

1. A clinical and radiological survey has been made of the families of thirty-one patients with peroneal spastic flat foot and tarsal coalition (twenty-seven calcaneo-navicular, four talo-calcaneal). 2. Thirty-nine per cent of ninety-eight first degree relatives were found to have some type of tarsal coalition. 3. A surprise finding was that not one of the first degree relatives had ever had symptoms referred to the tarsus. 4. No case of "ball and socket" ankle joint or of carpal coalition was found in this series.

Peroneal Spastic Flat Foot in Association with Congenital Tarsal Coalition

In the review of 370 cases of flat feet, pronated feet, and painful accessory scaphoids seen in our clinic during these ten years, seven cases of peroneal spastic flat foot with some congeital tarsal coalition were found out.These congenital tarsal coalitions included 2 cases of medial talocalcaneal coaliotin, a case of posterior talocalcaneal coalition, a case of total (anterior, medial and posterior) talocalcaneal coalition, 2 cases of calcaneonavicular coalition, and a case of talonavicular coalition. In the case of total talocalcaneal coalition, skoliosis and a fusion between carpal navicular and trapezium were found coexisted.Follow-up study of these cases clarified the following: incomplete talocalcaneal coalition were more resistant to conservative treatment than complete type, and remained still symptomatic. On the contrary, 2 Cases of incomplete calcaneonavicular coalition and a case of complete talonavicular coalition became asymptomatic with only a few month's conservative treatment.

Talocalcaneal coalition and new causes of peroneal spastic flatfoot.

Talocalcaneal coalition and new causes of peroneal spastic flatfoot.

Tarsal coalitions and peroneal spastic flat foot.

Tarsal coalitions and peroneal spastic flat foot.

Tarsal coalition: clinical significance and roentgenographic demonstration.

Coalition of the tarsal bones has been known for several centuries (15). Only within the last fifty years has it been associated with certain clinical situations. In 1921, Slomann (79) first related the calcaneonavicular bar to the clinical entity of peroneal spastic flat foot. It was soon evident that this relationship did not explain the etiology of all examples of peroneal spastic flat foot. Harris and Beath (36), in 1948, recognized that talocalcaneal bridge was also a cause of peroneal spastic flat foot. However, there still remain many cases which demonstrate the typical clinical findings but which have “normal” roentgenograms when examined by the usual technics. This problem stimulated our interest in the diagnosis and treatment of the various forms of tarsal coalition. It was apparent from a review of the world literature, that each advance in the understanding of tarsal coalition has been through the development of roentgenographic technics designed to illustrate the specific abnormalities. The use of tomography in examining the tarsal region has led us to recognize the significance of characteristic secondary roentgenographic signs. These signs, one of which has not been previously described, are produced by abnormal subtalar motion which is usually secondary to the coalition. A previously undescribed variant of talocalcaneal coalition involving the anterior facet of the calcaneus and talus will be presented. This occult coalition, hidden on routine views of the foot, explains some of the perplexing cases that present clinically as coalitions but have normal roentgenographic findings on routine studies. It is the purpose of this paper to review the causes and variations of tarsal coalition, to discuss the logical approach to the diagnosis of this condition, and to outline the treatment of the various types of coalition. Clinical Findings Tarsal coalition is the union of two or more tarsal bones into a single structure. The union may be fibrous (syndesmosis), cartilagenous (synchondrosis), or osseous (synostosis). It may be either congenital or acquired. The most common varieties of single coalition include the calcaneonavicular bar, talocalcaneal bridge, talonavicular, and calcaneocuboid coalitions. We would prefer, for scientific standardization, to term all these unions as coalitions, rather than by their popular synonyms, bars, or bridges. For brevity we shall abbreviate the four common coalitions noted above as CN, TC, TN, and CC respectively. Coalition has been demonstrated in the fetus (37, 61, 62, 81). The coalition is usually fibrous or cartilagenous at birth and no radiographic abnormalities may be noted. Good tarsal motion is feasible in the presence of a fibrous lesion. Some limitation of motion will occur with a cartilaginous lesion, and there is complete loss of joint motion in the presence of an osseous coalition. Therefore, the clinical abnormality is rarely detected at birth.

RETROSPECT—PERONEAL SPASTIC FLAT FOOT (RIGID VALGUS FOOT)

Peroneal spastic flat foot is most often caused by intertarsal fusions and of these the most important are medial talocalcaneal bridge and calcaneonavicular bar. In most cases the tarsal anomaly is easy to demonstrate by appropriate roentgenographic technique. Rudimentary forms of the medial talocalcaneal bridge are less easy to recognize because the roentgenographic findings are not quite so characteristic as is the case in complete medial talocalcaneal bridge. In such instances a medial operative approach will often demonstrate a rudimentary form of bridge. More knowledge of this problem is still required. Every opportunity should be utilized to determine the exact cause in every case of peroneal spastic flat foot which comes to operation. If the lesion is medial talocalcaneal bridge, or one of its variants, the operations should be performed from the medial side to determine the exact nature of the lesions as well as to facilitate the corrections of the valgus deformity.

TIBIALIS SPASTIC VARUS FOOT WITH TARSAL COALITION

1. Tarsal coalition often presents with the clinical picture of a peroneal spastic flat foot, but may present with a painful varus foot and spasm of the tibial muscles. 2. Three cases of tibialis spastic varus foot are described with a calcaneo-navicular bar as the associated anomaly. 3. Complete excision of the bar with interposition of the origin of the extensor digitorum brevis muscle appears to be a satisfactory method of treatment when carried out at a sufficiently early age.

A PROLONGED FOLLOW-UP OF PERONEAL SPASTIC FLAT FOOT

1. The radiographic appearances are no guide to prognosis or treatment of peroneal spastic flat foot. 2. Only 10 per cent of peroneal spastic flat feet are likely to cause severe persistent disability. 3. Severe symptomatic tarsal arthritis is exceptional in this condition.

PARTIAL CUBO-NAVICULAR COALITION AS A CAUSE OF PERONEAL SPASTIC FLAT FOOT

It is now recognised that congenital fusion between the talus and the calcaneum or between the calcaneum and the navicular bone is found in a high proportion ofpatients who have peroneal spastic flat foot. This paper presents an example of partial coalition between the cuboid and navicular bones. In the normal foot there may or may not be a synovial joint between these two bones. Oblique radiographs show well defined articular facets in approximately one quarter of the feet examined. In the remainder there is a space between the adjacent angles of the cuboid and navicular, the edges of the bones being irregular. It is important to appreciate that slight alterations in the obliquity of the x-rays can produce an overlapping of shadows which may suggest bony fusion. Further films, at varying angles, will demonstrate the true situation. Harris and Beath (1948) suggested that the typical congenital tarsal fusions occur in relation to accessory bones. The os cuboidum secundarium is found on the plantar surface of the foot at the point of contact between cuboid, navicular, calcaneum and talus (Trolle 1948). It may be fused to the navicular or cuboid, but more commonly to the former (O’Rahilly 1953). Jack (1954) suggested that coalition was due to an error in differentiation (possibly hereditary) which may lead to a large complete bony fusion at one extreme or to a small accessory bone at the other. Since an accessory bone may be present between the navicular and the cuboid, it is reasonable to suppose that coalition may occur between the two bones. Dwight (1907) illustrated by radiograph and photograph of the plantar surface of the bones of the foot what he described as synchondrosis of the navicular and cuboid, but it has not been possible to find any account of this particular abnormality as a cause of spastic flat foot.

Dysplasia epiphysialis hemimelica (tarso-ephiphysial aclasis).

Dysplasia epiphysialis hemimelica (tarso-ephiphysial aclasis).

Peroneal spastic flat foot.

1. This paper reports the investigation and the results of a line of treatment in thirty feet showing the peroneal spastic flat foot deformity. The questions that have aroused controversy are discussed, the evidence for previous opinions is examined, and some phenomena in relation to this condition are described. 2. It is suggested that previous opinions on this condition have been misleading, and have in many cases been made after incomplete investigation of too few cases. 3. Peroneal spastic flat foot can occur without a developmental tarsal anomaly. 4. The presence of a tarsal anomaly does not necessarily mean that the foot is incorrigibly stiff, and some of these feet show a full range of movement under anaesthesia. 5. There is no evidence from this series of cases to suggest that organic nervous disease or psychiatric disturbances played a significant part in the production of the deformity. 6. There is no evidence to suggest that the deformity is a manifestation of generalised rheumatoid arthritis. 7. This investigation does not reveal the cause of the deformity when the tarsal skeleton is normal, nor does it help to explain the reason for the onset of symptoms in a developmentally abnormal foot. 8. It is suggested that a tarsal anomaly makes the foot more likely, under average stress, to break down in this way, and that this deformity is also assumed by architecturally normal feet under heavy stress. In view of the frequency of minor tarsal anomalies among this series of thirty feet, it seems likely that all feet presenting the deformity of peroneal spastic flatness are to some degree structurally abnormal, although the exact site of the abnormality may escape us.

Bone anomalies of the tarsus in relation to peroneal spastic flat foot.

1. Twenty-three cases of tarsal anomaly—talo-calcaneal bridge or calcaneo-navicular bar—occurring among thirty cases of "peroneal spastic flat foot" have been studied. 2. The correlation between the clinical features and the mechanical defect is discussed.

Tarsal coalition, with special reference to roentgenographic interpretation.

The term “tarsal coalition” implies a fusion or union of two or more tarsal bones. It is not a rare entity, although a review of the literature might lead one to think this to be the case. The association of this lesion with painful flatfeet and more specifically “rigid flatfoot” makes the roentgenologic diagnosis important. The present paper is devoted to a discussion of coalition involving the calcaneonavicular and the talocalcaneal joints. Review of the Literature Tarsal fusion has long been recognized by anatomists. In 1880, Lagenbech (1) mentioned fusion of the calcaneal and navicular bones. Harris and Beath (2) described a specimen, prepared by John Hunter in 1885, showing bilateral fusion of the talus and calcaneus. Orthopedists have also been aware of tarsal coalition for some time. In 1921, Slomann (3) presented the x-ray findings in several cases of calcaneonavicular fusion. His cases included that of a 13-year-old boy with a six months history of pain in the left foot on walking. Another case was that of a 17-year-old girl with a history of pain in both feet on walking since the age of ten. Both of these patients had fusion of the calcaneus and navicular. In 1948, Harris and Beath (4) reported an incidence of 2 per cent of peroneal spastic flatfoot in the routine physical examination of 3,600 Canadians presenting themselves for army enlistment. This was a third of that for flexible flatfoot. These authors contend that the term “peroneal spastic flatfoot” has become a diagnostic “wastebasket” since painful flatfoot is frequently associated with peroneal pain and muscle spasm. Many orthopedists now agree that peroneal muscle spasm is secondary and not the primary cause of this condition. Badgley (16), Harris and Beath (4), and Coventry (6) believe that “rigid flatfoot” is more frequently due to tarsal anomalies, and they reserve the term tarsal coalition for this entity. It is pointed out that peroneal spasm is associated with inflammatory lesions of the tarsal bones, such as rheumatoid arthritis, with development of a valgus deformity of the feet secondary to peroneal spasm. These authors therefore advocate discarding the term “peroneal spastic flatfoot” for one specifically describing the pathologic changes. Etiology Tarsal coalition is thought to be a congenital anomaly. The term “calcaneonavicular bar,” by usage, includes bony, fibrous, and cartilaginous types of union. These types of union are also implied in the term “talocalcaneal bridge.” Coalition of the calcaneonavicular type may be related to the calcaneus secundarius, a rare sesamoid, occurring between the calcaneus and navicular. This was described by Holl (8) and Pfitzner (9). The latter author points out the relationship of this sesamoid to the os calcis, talus, navicular, and the cuboid. This would imply other possibilities of fusion that we have not encountered. Wagoner (10) reports a case of bilateral fusion of the os calcis and cuboid.