Talocalcaneal Coalition Resection Research Articles

Resection of Talocalcaneal Coalition With Calcaneal Lengthening Osteotomy: Short-to-Intermediate-Term Results.

The optimal surgical strategy for symptomatic tarsal coalition in pediatric patients remains debated. This study assessed the clinical and radiographic outcomes of addressing symptomatic talocalcaneal coalition through a combination of coalition resection and calcaneal lengthening osteotomy. Materialsand methods: We retrospectively reviewed cases of 10 children (11 feet) with symptomatic talocalcaneal tarsal coalition and painful flat feetwho were treated between 2017 and 2019. All underwent calcaneal lengthening osteotomy (CLO) and coalition resection (RC). In half of the cases, the Achilles tendon was lengthened, and two children underwent medial plication. We analyzed demographic, clinical, and radiographic data, including CT scans for coalition confirmation and joint evaluations. Pre- and postoperative radiographic measurements and American Orthopedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score assessed outcomes. The cohort, averaging 13.9 years at surgery, showed significant deformity correction. At follow-up (mean 54 months), six children were pain-free, and four experienced mild pain after intense activities. AOFAS scores were excellent or good. Complications included one superficial infection and mild forefoot supination in two children. No additional surgeries were needed. Resection of talocalcaneal coalition combined with CLO effectively corrects rigid flat foot and alleviates pain, providing reliable outcomes in symptomatic cases.

Total Arthroscopic Resection of the Talocalcaneal Coalition in Adults: Key Points of Surgical Technique.

Potential disadvantages of open technique for talocalcaneal coalition (TCC) include a risk of wound infection, opioid drug dependence, and prolonged hospitalization. The purpose of this study was to retrospectively evaluate the effectiveness and safety of endoscopic resection of the TCC. A retrospective study from June 2019 to February 2023was conducted on 16 consecutively admitted patients who were diagnosed by imaging to have TCC for whom conservative treatment had failed and who undergone arthroscopic resection. The mean age of this cohort was 31.56 ± 10.39 years (range, 16-57 years). The mean follow-up period was 38.93 ± 15.69 months (range, 11-59 months). The site of the coalition, comorbidities, satisfaction with treatment, visual analog scale (VAS), and American Orthopedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot scale scores were evaluated pre- and postoperatively. Preoperative magnetic resonance imaging (MRI) scans were used to categorize the coalition according to the Lim classification. Postoperative computed tomography (CT) scans were used to assess recurrence. The distribution of TCC cases according to the Lim classification was type I in one case, type II in four cases, and type III in 11 cases. The site of coalition involved the middle facets in seven patients, the posterior facets in three patients, and both the above sites in six patients. All patients underwent total arthroscopic resection of TCC. An auxiliary mini-incision was made for three patients due to serious tibial nerve compression. Radiographics showed that the coalition disappeared and pain was relieved postoperatively. The mean VAS score decreased from 4.31 ± 1.54 to 1.81 ± 0.98 points (p < 0.001). The mean AOFAS ankle-hindfoot score improved from 65.56 ± 5.82 to 87.31 ± 6.30 points (p < 0.001). Fifteen patients were satisfied with the procedure, and one patient experienced numbness after surgery. No recurrence was reported based on CT scan and clinical results up to the end of the study. Surgical reconstruction employing total arthroscopic resection of TCC can achieve significant functional and radiographic improvements and symptom relief in selected patients with TCC. Auxiliary mini-incisions were necessitated in complex situations.

Comparative analysis of clinical outcomes of talocalcaneal coalition resection: subtalar joint middle and posterior facet involvement versus isolated posterior facet involvement – a retrospective cohort study

BackgroundDespite coalition resection being the preferred treatment for talocalcaneal coalition (TCC), postoperative complications, suboptimal functional recovery, and recurrence risks remain challenges. Although current TCC classification systems guide personalized surgical plans, the impact of middle and posterior facet coalitions on TCC resection surgery’s effectiveness is still poorly understood. Therefore, this study aims to compare the clinical outcomes of TCC patients with and without involvement of the subtalar joint’s (STJ) middle and posterior facets undergoing coalition resection to explore the potential impact of these coalitions on surgical outcomes.MethodsWe conducted a retrospective study on 115 patients who underwent coalition resection surgery due to symptomatic TCC between November 2009 and February 2023. According to preoperative CT scan results, patients were divided into an isolated posterior facet coalition (P-type) group and a middle-posterior facet coalition (MP-type) group. Demographic characteristics (including age, sex, body mass index (BMI), follow-up time, and medical history duration), pre-and postoperative assessments (including Visual Analog Scale (VAS), American Orthopaedic Foot & Ankle Society (AOFAS) score, Pain Interference (PI) and Physical Function (PF) scores from the Patient-Reported Outcomes Measurement Information System (PROMIS)), as well as postoperative self-assessment of efficacy (excellent, good, fair, poor) and hindfoot stiffness, were compared between the two groups. Postoperatively, TCC recurrence was evaluated through imaging follow-up examinations.Results69 patients meeting the inclusion criteria were included, with 30 patients in the P-type group and 39 in the MP-type group. There were no statistically significant differences between the two groups in demographic characteristics (P<0.05). There were also no statistically significant differences between the two groups in preoperative VAS score, AOFAS score, PI score, and PF score. However, postoperatively, there were statistically significant differences between the two groups in VAS score (1(1,1.5) vs. 2(1,2), P<0.01), AOFAS score (92.5(87,96.5) vs. 82(69.5,87), P<0.01), PI score (39(39,43) vs. 39(39,51), P = 0.014), PF score (73(61,73) vs. 55(51,73), P = 0.001), fair or poor outcome (4(13%) vs. 14(35.9%), P = 0.034), and hindfoot stiffness (3(10.3%) vs. 16(37.2%), P = 0.011). There was no statistically significant differences in the recurrence rate between the two groups postoperatively (0(0%) vs. 3(7.69%), P = 0.252).ConclusionEven with complete coalition resection during surgery and rehabilitation following standardized protocols, the surgical outcomes in MP-type TCC patients are still inferior to those in P-type patients.

Coalition Excision and Corrective Osteotomies versus Coalition Excision and Arthroereisis in the Management of Pes Planovalgus with Talocalcaneal Coalition in Adolescents: A Randomized Controlled Trial

Abstract Level of evidence: ΙΙ Background Talocalcaneal coalition is the most common cause of rigid flat foot in adolescents. It presents with recurrent ankle sprains, ankle pain, and foot deformity. Management is still controversial. Multiple options were utilized during the last 40 years, including arthroerisis; however, the role of arthroerisis in the management of rigid pes planovalgus remains questionable. Patients and Methods Thirty feet in 28 patients with rigid flat foot due to talocalcaneal coalition who presented to our institution between September 2018 and November 2020 were prospectively analyzed. Randomization was performed by random allocation using a computer- based system into two groups: group A for arthroereisis and coalition excision and group B for osteotomies and coalition excision. Functional and radiological outcomes and complications were recorded and analyzed using Statistical Package for Social Sciences software. Results Thirty feet in 28 patients were included in the final analysis (group A, 15 feet; group B, 15 feet). The mean age and follow-up duration of the participants were 14.5 years and 24 months, respectively. The mean AOFAS and foot and ankle ability measurement scores were 78.8±4.04 and 76.73±4.66 and 80±5 and 79±3 for groups A and B, respectively. The complication rate was higher in group A; however, this difference did not reach statistical significance. No difference was found regarding functional outcomes. Conclusion We believe that the combination of talocalcaneal coalition resection with either corrective osteotomies or arthroerisis resulted in a significant improvement of functional and radiological outcomes with no difference between both in the management of rigid pes planovalgus.

Talocalcaneal Coalition Resection with Local Fat Grafting and Flatfoot Reconstruction.

Talocalcaneal (TC) coalitions typically present in the pediatric population with medial hindfoot and/or ankle pain and absent subtalar range of motion. Coalition resection with fat interposition is well described for isolated tarsal coalitions1,2; however, patients with concomitant rigid flatfoot may benefit from additional reconstructive procedures. To address this, we employ the surgical technique of TC resection with local fat grafting and flatfoot reconstruction. This procedure is described in 3 steps: (1) gastrocnemius recession and fat harvesting, (2) TC coalition resection with local fat interposition, and (3) peroneus brevis Z-lengthening and calcaneal lateral column lengthening osteotomy with allograft. A 3 to 4-cm posteromedial longitudinal incision is made at the distal extent of the medial head of the gastrocnemius muscle. The gastrocnemius tendon is identified, dissected free of surrounding tissue, and transected. Superficial fat is then harvested from this incision before wound closure. A 7-cm incision is made from the posterior aspect of the medial malleolus to the talonavicular joint. The neurovascular bundle and flexor tendons are dissected carefully from the surrounding tissue as a group and protected while the coalition is completely resected, and bone wax and the local fat are utilized at the resection site to prevent regrowth of the coalition. An approximately 7-cm incision is then made laterally and obliquely following the Langer lines and centered over the lateral calcaneus. The peroneal tendons are released from their sheaths, and the peroneus brevis is Z-lengthened. A calcaneal osteotomy is performed about 1.5 cm proximal to the calcaneocuboid joint and angled to avoid the anterior and middle subtalar facet joints. Two Kirschner wires are inserted retrograde across the calcaneocuboid joint, and the calcaneal osteotomy is opened. A trapezoid-shaped allograft bone wedge is impacted, and the Kirschner wires are advanced across into the calcaneus. The lengthened peroneus brevis tendon is repaired, and the wound is closed in a layered fashion. First-line treatment is nonoperative with orthotics and immobilization. Surgical options include coalition resection with or without calcaneal lengthening osteotomy, arthrodesis, or arthroereisis. Following coalition resection, various grafts can be utilized, including fat autografts, bone wax, or split flexor hallucis longus tendon3-6. This procedure addresses TC coalition with concomitant rigid flatfoot. Resection alone may increase subtalar motion but does not correct a flatfoot deformity. Historically, surgeons performed arthrodesis or arthroereisis, but these are rarely performed in young patients. In patients with coalitions involving >50% of the posterior facet or preexisting degenerative changes, arthrodesis may be indicated7. Patients can expect improvement in pain and function8-11. Previous investigators reported improved patient satisfaction, improved range of motion, clinical and radiographic hindfoot correction, and an improved American Orthopaedic Foot & Ankle Society hindfoot score at the time of final follow-up8,9. Carefully free the neurovascular bundle from the surrounding soft tissue so that it can be carefully retracted away from the area of coalition resection.Utilize the interval between the posterior tibialis and flexor digitorum longus tendons to approach the coalition.Expose the medial wall of the coalition and perform a careful resection that avoids inadvertently diverging into the body of the talus or calcaneus.Place a smooth lamina spreader into the resected area and gently open the subtalar joint to confirm complete coalition resection.Place 2 retrograde wires across the calcaneocuboid joint before performing the osteotomy. Without this step, up to 50% of cases experience calcaneocuboid subluxation and/or rotation after the lateral column lengthening12.To determine the size of the allograft, place a lamina spreader into the osteotomy site to measure the width.If present, rigid supination of the forefoot must be corrected with a medial cuneiform plantar-based closing osteotomy. AOFAS = American Orthopaedic Foot & Ankle SocietyFADI = Foot and Ankle Disability IndexMRI = magnetic resonance imagingCT = computed tomographyOR = operating roomK-wire = Kirschner wire.

Hindfoot joint kinematics analysis after the resection of talocalcaneal coalition

BackgroundThe subtalar joint movement between the talus and calcaneus is restricted in patients with talocalcaneal coalition (TCC). When the motion of the subtalar joint is restricted, shock absorption in the foot decreases, leading to pain during walking. Resection methods to maintain subtalar motion by removing abnormal unions have been proposed. The purpose of this study was to analyze the joint kinematics of patients who underwent TCC resection and to quantitatively evaluate the results of the surgery based on the measured kinematics. MethodsJoint kinematics of five patients with TCC were obtained using a biplane fluoroscopic imaging system and an intensity-based two-/three-dimensional registration method. The joint kinematics of the tibiotalar and subtalar joints and the tibiocalcaneal motion during the stance phase of walking were obtained. From the kinematics of the hindfoot joints, the inversion/eversion range of motion (ROM) of the patients before and after resection was statistically analyzed using the Wilcoxon signed-rank test to test whether TCC resection improved the ROM. ResultsDuring the loading response period, the eversion ROM of the subtalar joint and tibiocalcaneal motion significantly increased postoperatively. In addition, a significant postoperative increase was observed in the subtalar and tibiocalcaneal inversion ROM during the pre-swing period. SignificanceTCC resection surgery increased the ROM of the subtalar joint, which in turn contributed to the increase in tibiocalcaneal ROM. Increased subtalar and tibiocalcaneal ROM could result in increased shock attenuation and may be a contributing factor to pain relief during walking.

Coalition excision and corrective osteotomies versus coalition excision and arthroereisis in management of pes planovalgus with talo-calcaneal coalition in adolescents: A randomized controlled trial

BackgroundTalocalcaneal coalition is the most common cause of rigid flat foot in adolescents. It presents with recurrent ankle sprains, foot and ankle pain, and foot deformity. Management is still controversial. Multiple options were utilized during the last 40 years, including coalition excision only or coalition excision with hind foot arthrodesis or corrective osteotomies. However, the effect of arthroereisis after coalition excision is still questionable. Patients and methodsThirty feet in 28 patients with rigid flat foot due to talocalcaneal coalition, who presented to our institution between September 2018 and April 2020, were prospectively analyzed. Randomization was performed by random allocation using a computer-based system into two groups: group A for coalition excision and arthroereisis, group B for coalition excision and osteotomies. Functional and radiological outcomes and complications were recorded and analyzed using Statistical Package for the Social Sciences software. ResultsThirty feet in 28 patients were included in the final analysis (15 feet in each group). One patient in each group had bilateral affection. The mean age was 14.5 years, and the mean follow-up duration was 24 months. At final follow-up, the mean AOFAS was 78.8 ± 4.04 in group A and 76.73 ± 4.66 in group B, while the FAAM scores were 80 ± 5 and 79 ± 3 in groups A and B, respectively. The complication rate was higher in group A, however with no statistical significance. ConclusionThe combination of talocalcaneal coalition resection with either corrective osteotomies or arthroereisis had a significant improvement of functional and radiological outcomes in the management of rigid pes planovalgus.

An update on tarsal coalitions

Tarsal coalitions are anomalous connections between two or more bones in the hindfoot or midfoot secondary to embryonic failure of segmentation and differentiation of the mesenchyme. Calcaneonavicular and talocalcaneal coalitions are the most common. Although it is a congenital deformity, presentation is usually in adolescence which coincides with ossification of the coalition. Patients typically present with diffuse foot pain, calf muscle pain, recurrent ankle ligament sprains and a rigid hindfoot valgus deformity. Initial management is non-operative and may involve activity reduction, a trial of immobilization in a walking boot or cast, physiotherapy, corticosteroid injections and regular analgesia. Close to a third of patients experience symptom relief but the remaining patients with persistent symptoms will require operative intervention. Patients without degenerative joint disease undergo resection of the coalition. It is now established that an associated severe hindfoot valgus foot should be addressed at this stage to prevent inevitable future joint degeneration. The indications for joint fusion remain unclear and the tendency is to postpone this when possible until a later age. In recent years, arthroscopic resection of talocalcaneal coalitions has gained popularity, despite being technically demanding. It gives good visualization of the coalition, better postoperative pain relief and quicker improvement of the hindfoot stiffness.

Application of mixed reality technology in talocalcaneal coalition resection.

With positive outcomes recorded, the mixed reality (MR) technology has lately become popular in orthopedic surgery. However, there are few studies that specifically address the utility of MR in talocalcaneal coalitions (TCC) resection. Our goal in this retrospective study is to assess certain data while examining the viability of using MR to treat TCC resection. Six consecutive patients with TCC diagnosed by computed tomography (CT) for which nonoperative therapy had failed and MR system assisted TCC resection were included in this study from March 2021 to December 2021. The feasibility and accuracy of TCC resection were assessed by post-operation radiography. The American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score and visual analog scale (VAS) score were used to assess the recovery condition and pain level pre- and post-operation. The surgeon can accurately resect the TCC according to the preoperatively determined range by superimposing the holographic model with the actual anatomy of the TCC using an MR system. Additionally, no additional x-ray was necessary while operating. Mean follow-up was 10.3 months, with a minimum of 6 months. There is a significant difference between the preoperative AOFAS score of 53.4 ± 3.8 and the 6-month follow-up AOFAS score of 97.3 ± 2.2 (p < 0.05). There is also a significant difference between the preoperative VAS score of 8.1 ± 0.7 and the 6-month follow-up VAS score of 1.7 ± 0.4 (p < 0.05). All individuals had clinical subtalar mobility without stiffness following surgery. While the TCC resection operation is being performed, the application of MR technology is practicable, effective, and radiation-free, giving surgeons satisfactory support.

Bilateral talocalcaneal tarsal coalition with flatfeet treated with single-stage coalition resection and calcaneal lengthening osteotomy: A case report

A coalition is a bridge connecting osseous structures. Tarsal coalitions typically involve talocalcaneal and calcaneonavicular joints. As a result, patients might present with pain and/or rigid flatfoot deformity. We outline a case of bilateral middle facets talocalcaneal tarsal coalition with rigid flatfeet who was treated with resection combined with flatfoot reconstruction. the patient was an 11-year-old Saudi girl who had progressive bilateral flatfoot for which non-operative treatment failed. A single-stage middle facet talocalcaneal coalition resection with concomitant Evans calcaneal lengthening osteotomy and gastrocnemius recession was performed. Postoperatively, the American Orthopaedic Foot and Ankle Society (AOFAS) ankle midfoot score was measured, and the patient had a score of 90/100. The outcome was satisfactory, and the other foot was operated on 6 months later, with the same procedure and outcome (AOFAS: 90/100). Six years of follow-up showed no recurrence and a satisfactory lifestyle with no activity limitation. We aimed to highlight the AOFAS score 6 years after resecting the coalitions while reconstructing the foot in a single-staged procedure.

Talocalcaneal Coalition Resection in the Adult Population: A Systematic Review.

Tarsal coalition is a congenital malformation of the tarsal bones of the foot that typically presents with features such as pain, recurrent sprains, and flat foot in childhood. In a small number of patients, a delayed presentation may be apparent, with symptoms instead presenting in adulthood. The most commonly accepted hypothesis is that the tarsal coalition becomes more symptomatic as the coalition progressively ossifies. To this date, no author has systematically evaluated the literature to identify the best approach when surgically managing these patients, in particular concerning the resection of the coalition.This study aims to systematically review the literature, searching EMBASE, MEDLINE, Web of Science, Google Scholar, and the Cochrane Library to identify and evaluate studies that presented an outcome for resection of the adult talocalcaneal coalition. Alongside overall outcomes, details on the extent of the coalition, surgical method, post-operative regimen, and presenting symptoms were extracted for each patient studied. This was conducted in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.With 72 patients, this is the largest evaluation of an adult tarsal coalition population to date. Our findings indicate that talocalcaneal coalition in adulthood presents differently from the classical peroneal spasm found in childhood. Better scores were reported for coalitions either managed with an endoscopic approach or with interposition of the flexor hallucis longus tendon. Despite some reported benefits in the literature, a trial of conservative management or the use of a rehabilitation regimen had a limited impact on the overall patient outcome.Tarsal coalition in adulthood requires rigorous clinical evaluation to identify appropriate management options. Resection of the coalition is a safe approach to definitively managing these patients, but consideration should be given to the surgical method to ensure each patient has the best outcomes. In particular, consideration should be given to using an endoscopic approach or interposition of the flexor hallucis longus tendon in order to achieve the best patient outcomes. However, there remains a paucity of literature evaluating this demographic and further high-impact studies are required to comprehensively evaluate this population.

Lateral Arthroscopic Subtalar Arthrodesis for Talocalcaneal Coalition: Surgical Technique

Resection of symptomatic talocalcaneal coalitions (TCCs) has been performed for patients with normal tarsal joints and <50% involvement of the subtalar joint. For those with TCCs >50% of subtalar articulation or/and subtalar arthritis, a subtalar arthrodesis is done. The purpose of this Technical Note is to describe the arthroscopic resection of TCC and talocalcaneal arthrodesis during the same procedure by using a 2 lateral portal technique. With the patient in lateral decubitus under general or locoregional anaesthesia, the foot and ankle are extended beyond the edge of the surgical table. A lateral portal is created 1 cm anterior to the tip of the lateral malleolus in which the arthroscope is introduced. The anterolateral portal is created 1 cm inferior and 2 cm anterior to the tip of the lateral malleolus. The posterior subtalar surface is prepared progressively. The TCC resection is completed. The fixation is obtained with 2 cannulated screws. The arthroscopic resection of TCC and subtalar arthrodesis during the same procedure by using 2 lateral portals can be done for correctly selected patients.

Morphologic Analysis of Nonosseous Talocalcaneal Coalitions Using 3D Reconstruction.

Background:Resection of talocalcaneal coalitions has generally involved osseous coalitions. We attempted to evaluate the morphology of nonosseous talocalcaneal coalitions. This study aimed to investigate if the calcaneal articular surface area of feet with talocalcaneal coalitions is different than that of normal feet.Methods:Twenty nonosseous talocalcaneal coalition cases with analyzable computed tomography (CT) scans were compared to 20 control cases. Three-dimensional models of the talus and calcaneus were constructed, and the surface areas of the posterior facet (SPF), whole talocalcaneal joint of the calcaneus (SWJ), and coalition site (SCS) of each 3D-CT model were measured. “Calibrated” values of the 2 groups were created to adjust for relative size of the tali and then compared. The preoperative and postoperative AOFAS Ankle-Hindfoot scale was calculated for 9 cases that had undergone single coalition resection.Results:The calibrated SPF and SWJ were significantly greater in the coalition group than in the control group (40% and 12%, respectively). No significant difference was detected between the calibrated (SWJ – SCS) value of the coalition group and the calibrated SWJ value of the control group. The AOFAS scale was improved postoperatively in all 9 cases analyzed.Conclusion:The calcaneal articular surface of nonosseous talocalcaneal coalition feet in our series was larger than that of the normal feet. This study indicates that the total calcaneal articular surface after coalition resection may be comparable to the calcaneal articular surface of normal feet. We suggest that the indication for coalition resection be reconsidered for nonosseous coalition.Level of Evidence:Level III, retrospective comparative study.

Operative versus nonoperative treatment in children with painful rigid flatfoot and talocalcaneal coalition

BackgroundThe management of painful rigid flatfoot (RFF) with talocalcaneal coalition (TCC) is controversial. We aimed to compare operative and nonoperative treatment in children with RFF and TCC.MethodsWe retrospectively reviewed medical records and radiographs of children with RFF and TTC treated between 2005 and 2015. The nonoperative treatment consisted of manipulation under anesthesia, cast immobilization and shoe insert after cast removal. The operative treatment consisted of combined TCC resection, graft interposition and subtalar arthroereisis.ResultsThirty-four children (47 ft) in the nonoperative group and twenty-one children (34 ft) in the operative group were included. No differences were found between groups, concerning baseline characteristics. The mean age at treatment was 11.8 years (9–17): 11.6 (9–17) for the nonoperative group, 12.2 (10–15) for the operative group. The mean follow-up averaged 6.6 (3–12) years and was significantly longer in the nonoperative group (7.8 versus 4.7 years; p < 0.0005), since the operative procedure was increasingly practiced in the latest years.There were no complications in either groups, but 6 patients (7 ft) in the nonoperative group were unsatisfied and required surgery. At the latest follow-up, the AOFAS-AHS improved in both groups, although the operative group showed significantly better improvement. The operative group reported also significantly better FADI score, after adjustment for follow-up and baseline variables.ConclusionThe operative treatment showed better results compared to the nonoperative treatment. Symptomatic RFF with TCC in children can be effectively treated in one step with resection, graft interposition and subtalar arthroereisis. Further prospective randomized studies are needed to confirm our findings and to identify the best operative strategy in this condition.

Effectiveness of a modified posterior approach for arthroscopic resection on painful talocalcaneal coalition in adults

To investigate the effectiveness of arthroscopic talocalcaneal coalition resection in painful adults via a modified posterior approach. Between January 2015 and December 2017, 9 patients with painful talocalcaneal coalition accepted arthroscopic resection via the posterior malleolus high lateral observation approach combined with the lower medial operation approach. Of them, 6 were male and 3 were female, aged from 19 to 30 years (mean, 24 years). Among them, 2 cases had no definite local trauma and 7 cases had a history of sprain of foot and ankle. The disease duration ranged from 6 to 30 months, with a median of 12 months. Rozansky classification of talocalcaneal coalition for the 9 patients: 5 cases (5 feet) were type Ⅰ, 2 cases (2 feet) type Ⅱ, and 2 cases (2 feet) type Ⅲ. The patients had no sequelae of limb dysfunction and no limb joint surgery in the past. All the patients received anteroposterior and lateral X-ray films and CT scans of the ankle joint during follow-up. The visual analogue scale (VAS) score and American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hind foot score were used to evaluate the effectiveness. The operation time was 60-90 minutes (mean, 76 minutes). All patients were followed up 12-24 months (mean, 18 months). All the incisions healed by first intention, without infection, skin necrosis, lower extremity deep vein thrombosis, vascular nerve and tendon injury, bone bridge recurrence, and other complications. The ankle function recovered well and the pain was relieved obviously after operation, and the patients returned to work at 3-5 months after operation, with an average of 3.9 months. At last follow-up, the VAS score was 0.7±0.5, which was significantly improved ( t=20.239, P=0.000) when compared with preoperative score (4.2±0.5); the AOFAS ankle-hind foot score was 94±4, which was significantly improved ( t=-27.424, P=0.000) when compared with preoperative score (62±2). According to AOFAS ankle-hindfoot scoring system, the results were excellent in 7 cases and good in 2 cases at last follow-up. It is more intuitive, more space, and more flexibility for operation via the modified posterior malleolus high lateral observation approach combined with the lower medial operation approach in talocalcaneal coalition. It is feasible to remove talocalcaneal coalition programmatically according to the specific anatomic signs during the operation.

Talocalcaneal Coalition Resection with Corrective Osteotomies in Symptomatic Adolescents

Category:HindfootIntroduction/Purpose:Resection of a symptomatic talocalcaneal coalition in an adolescent without correction of the planovalgus deformity aggravates the problem because the tight peroneal tendons and triceps surae pull the heel into more valgus after release of the subtalar joint. This study aims to evaluate the clinical results of resection of symptomatic talocalcaneal coalition in adolescents with simultaneous correction of the planovalgus deformity using combined bony and soft tissue procedures.Methods:In 24 feet in 21 adolescents (age 13 to 17) with symptomatic talocalcaneal coalition and planovalgus deformity, resection of the coalition was performed together with simultaneous medial displacement calcaneal osteotomy, lateral column lengthening, Cotton osteotomy if needed, gastrocnaemius recession, and peroneal tendon fractional lengthening. Follow up evaluation was done using the AOFAS hindfoot score and subjective patient satisfaction. Complications and reoperation were reported.Results:After a minimal follow up of one year (range 1 to 5 years), the results were classified excellent in 12 feet, good in 8 feet, and fair in four feet using the AOFAS hindfoot score. Subjective patient satisfaction was graded excellent in 14 feet, good in 6 feet and fair in four feet. Two patients underwent subsequent subtalar fusion with subsequent improvement and satisfaction. Other complications included superficial wound problems in 5 feet, and talar incomplete fracture during coalition resection which was fixed in one foot.Conclusion:Resection of a symptomatic talocalcaneal coalition with simultaneous correction of pes planovalgus deformity is a good option for management of such problem in adolescents.

Technique Article: Tarsal Coalition Resection Using Kirschner Wires Across the Subtalar Joint in a Two-Incision Approach

Subtalar coalitions are a significant cause of morbidity, especially in the pediatric population. Arthrodesis was considered the standard of care, with coalitions involving >50% of the joint until the mid-1990s. Today, some are recommending resection of the coalition first and to save hindfoot arthrodesis as a salvage procedure. As a result, resection of talocalcaneal coalitions is becoming more common, and optimizing the surgical technique is a necessity in the field of orthopedics. We present a technique to optimize surgical resection of talocalcaneal coalitions by using Kirschner wires inserted from the lateral side, which allows us to demarcate the coalition. This gives us a greater ability to perform a more complete resection and also helps prevent iatrogenic trauma to the articulating surface.

3D Printing Surgical Guide for Talocalcaneal Coalition Resection: Technique Tip.

3D Printing Surgical Guide for Talocalcaneal Coalition Resection: Technique Tip.

Subtalar coalition resection utilizing live navigation: a technique tip.

PurposeDescribe the surgical technique of talocalcaneal coalition resection using live CT navigation.MethodsA ten-year-old female with left talocalcaneal coalition hindfoot pain refractory to conservative management underwent surgical coalition resection using live CT navigation. The procedure and discussion of this technique is described in detail.ResultsWith minimal radiation exposure to the patient, CT navigation for this complex talocalcaneal coalition was both helpful and potentially timesaving by allowing immediate localization and guided resection of the coalition.ConclusionIn the case of a complex subtalar coalition resection, CT navigation poses minimal patient radiation exposure and allows immediate localization and guided resection of the coalition.Level of EvidenceLevel V

Intraoperative Three-Dimensional Navigation for Talocalcaneal Coalition Resection

Talocalcaneal tarsal coalitions are a common source of foot pain, stiffness, and deformity. These coalitions are treated symptomatically with rest and periods of immobilization. When those measures fail, surgical resection is attempted. This procedure is an anatomic challenge with the consequence of leaving residual coalition. The residual coalition primarily results from difficulty with intraoperative imaging because fluoroscopy does not provide adequate detail of this area. Some investigators have recommended intraoperative computed tomography after resection with reasonable results. We describe the combination of an intraoperative computed tomography with a navigated instrument system for resection of talocalcaneal coalitions. The use of a navigated probe and burr aids in defining the most anterior, posterior, and medial extents of the coalition. This technique reduces the morbidity, with less bone removed and preservation of intact subtalar articulations and allows for an efficient, thorough, and controlled resection.