Symptomatic Talocalcaneal Coalition Research Articles

Posterior arthroscopic subtalar arthrodesis for symptomatic adult talocalcaneal coalition

Objective: To investigate the functional outcomes of posterior arthroscopic subtalar arthrodesis (PASTA) for adult patients presenting with symptomatic talocalcaneal coalition. Methods: The study was a retrospective case-series research.The data of 17 adult patients (17 feet) with symptomatic talocalcaneal coalitions,treated with PASTA from March 2018 to February 2022 in Xuzhou Central Hospital were collected.This procedure involved 10 males and 7 females,aged (42.4±7.5) years(range:31 to 58 years).There were 9 cases on the right side and 7 cases on the left side.According to the Rozansky classification,there were 4 cases of type Ⅰ,7 cases of type Ⅱ, 3 cases of type Ⅲ,3 cases of type Ⅳ.The following items such as wound healing and bony union of the subtalar joint were observed.Clinical assessment was performed using pain visual analogue scale (VAS),American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot scores and 36-item short form health survey (SF-36) scores.The paired t test was used for data comparison. Results: The follow-up time was (24.8±6.9) months(range:12 to 40 months).There were no complications such as wound infection,deep vein thrombosis,nonunion,or screw breakage.One patient with preoperative spasm,relieved after the second surgical procedure (peroneal brevis tendon lengthening).The union time of the subtalar joint was (8.8±2.2) weeks(range:6 to 12 weeks).At the final follow-up,the VAS decreased from (6.4±1.3) to (1.3±0.9)(t=14.114,P<0.01), the AOFAS ankle-hindfoot score increased from (49.0±8.1) to (90.0±5.1)(t=38.782,P<0.01),and the SF-36 score increased from (50.8±9.5) to (91.0±4.9)(t=20.468,P<0.01). Conclusion: PASTA for adult patients presenting with symptomatic talocalcaneal coalition offers advantages of minimal trauma,fast recovery,and few complications,which is an effective method.

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.

The Efficacy of Intra-articular Subtalar Steroid Injection for Symptomatic Talocalcaneal Coalitions: A 30-Year Single Institution Experience.

While intra-articular steroid injection has been used anecdotally in patients with symptomatic talocalcaneal coalitions recalcitrant to traditional conservative modalities, the ability of this treatment to provide symptomatic relief and obviate or delay surgical intervention remains unknown. The purpose of this study is, therefore, to assess the treatment efficacy of intra-articular subtalar steroid injection in children with symptomatic talocalcaneal coalitions. A retrospective study of all patients with isolated subtalar coalitions was performed at a single pediatric orthopaedic institution over a 30-year period. Radiographs were analyzed to identify the type of coalition (osseous or nonosseous), presence of any posterior facet involvement, and presence of a planovalgus foot deformity. Patients who underwent a subtalar joint steroid injection after failing other conservative treatments were identified and compared with those who did not receive an injection as part of their nonoperative management with regard to the need for ultimate surgical intervention and the time from presentation to surgery when applicable. A total of 83 patients (125 feet) met inclusion criteria, of whom 25 patients (34 feet) received a subtalar steroid injection. When compared with the 58 patients (91 feet) treated with standard nonoperative modalities, there were no differences with regard to sex, age at presentation (12.4 and 12.3 y, respectively), facet involvement, type of coalition, or the presence of a planovalgus deformity. In all, 12/34 (35%) feet in the injection group eventually elected surgical intervention compared with 36/91 (39%) feet that did not receive an injection (P=0.72). For those patients ultimately selecting surgical intervention, the average time from initial presentation to surgery was 878 days in the injection group versus 211 days in the noninjection group (P<0.001). While subtalar steroid injection can alleviate symptoms in some patients with a talocalcaneal coalition, this intervention does not appear to decrease the need for surgery when compared with traditional nonoperative therapies. In patients failing other forms of conservative treatment, subtalar steroid injections can delay surgical intervention by an average of nearly 2 years. Level-III-therapeutic study.

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.

Osseous bridge resection for the treatment of adult talocalaneal coalitions without arthritis

To analyze clinical outcomes of osseous-bridge resection for the treatment of adult symptomatic talocalcaneal coalitions without arthritis. The clinical data of 12 patients (15 feet) with symptomatic talocalcaneal coalitions without arthtitis from January 2013 to June 2016 were respectively analyzed. All cases were secondary talocalcaneal coalition. There were 9 males (11 feet) and 3 females (4 feet) with a mean (26.6±3.3) years old (ranged, 18 to 33 years old). According to the Rozansky classification, there were 4 (6 feet) type I, 3 (3 feet) type II, 2 (2 feet) type III, 1 (1 feet) type IV, and 2 (3 feet) type V. All patients received coalition resection and interposition of fat graft. Complication, recurrence and range of motion was regularly recorded after operation. Clinical efficacy was evaluated according to the visual analogue scale (VAS) and the American Orthopedic Foot and Ankle Society (AOFAS) ankle hindfoot scale. All patients were followed up for an average duration of (28.7±18.3) months (ranged, 12 to 48 months). All the incisions were primarily healed. There were no wound necrosis, infection, neurovascular or tendon injuries. Range of motion was improved in 13 feet. All patients returned back to work. Recurrence happened in 1 case 2 years after surgery, the patient received a secondary coalition resection. At the latest follow-up, VAS was 2.1±0.8 and AOFAS score was 82.7±7.2, were siginificantly improved when compared with the preoperative scores(8.2±0.7, t=6.233, P<0.01; 48.4±6.8, t=5.747, P<0.01). For adult patients with symptomatic talocalcaneal coalitions without arthritis, simple coalition resection could provide good clinical outcomes with minimal complications.

Endoscopic Resection for Talocalcaneal Coalition Using Posteromedial Approach

Category: Hindfoot Introduction/Purpose: Initial treatment of symptomatic talocalcaneal coalition (TCC) is reduced activity or cast immobilization. If these conservative treatments does not relieve symptoms, surgical treatment is recommended. The operation for TCC is usually treated by an open procedure. We report the results of the three cases by endoscopic resection using posteromedial approach. Methods: Three consecutive patients (3 feet, 2 men and 1 female) who underwent surgery for TCCs were reviewed. Patient’s age at the time of surgery were 12, 13, 19 years respectively. All patients suffered from a foot pain after ankle sprain. Two patients didn’t play sports because of this pain. This operation is performed in the supine position. Two portals are each created at the proximal and distal to the vertex of the medial malleolus. Portal positions are marked by use of sonography to avoid the injury of tendons and neurovascular. By use of a shaver a radiofrequency device, as much soft tissue must be removed as possible to allow easy coalition resection, the surgeon performs sufficient resection of the coalition using an abrader until the normal articular surface can be confirmed. Movements of ankle and toes are encouraged from immediately post-operatively. Weight bearing is permitted 1 week after surgery. Results: All patients had a relief of pain. The mean preoperative and final follow-up AOFAS ankle-hind foot scale scores were from 65.3 to 92.3. Two patients returned to playing sports by three months. The mean operation time was 123 minutes (range: 97–148 minutes). However, compared with the initial cases, recent cases tended to have shorter surgical times. No complications occurred. Conclusion: A posteromedial approach for TCC is a useful technique because the advantage of allowing (1) a direct approach to both the middle- and posterior-facet coalitions without obstruction, (2) the creation of sufficient working space, (3) the obtuse insertion angle between the endoscope and instrument. On the basis of these advantage, endoscopic resection of a TCC using the posteromedial approach is considered a useful technique. To decrease the risk of neurovascular damage and tendon injury, portal positions are marked in advance by use of sonography, so that, a safe endoscopic resection of the coalition is performed.

Coalition resection and medial displacement calcaneal osteotomy for treatment of symptomatic talocalcaneal coalition: functional and clinical outcome

The purpose of this study was to evaluate the functional and clinical outcome of combined TCC resection and medial displacement calcaneal osteotomy for treatment of symptomatic talocalcaneal coalition. This is a prospective case series study on 27 patients (30 feet) who had symptomatic rigid pes planovalgus due to talocalcaneal coalition. All patients were treated by coalition resection and medial displacement calcaneal osteotomy. Pre-operative clinical and radiological assessment was done. Pain was assessed by visual analogue scale (VAS) and the functional assessment was done by the American Foot and Ankle Society score (AOFAS) for the hind foot. Pre-operative and postoperative plantar pressure assessment was done for all patients barefoot using the mat scan (Tekscan, Inc., vs. 6.34, Boston, USA). The mean follow-up period was 27.44 months (±2.47, range 23-33). Heel valgus improved from 15.03 (±6.9) degrees pre-operative to 3.09 (±2.3) degrees postoperatively. There was a statistically significant improvement in the VAS from 8.48 (±0.70) pre-operative to 3.70 (±1.13) postoperative. The mean AOFAS score showed statistically significant improvement from 39.88 (±6.09) pre-operative to 84.37 (±7.06) postoperative. There was a statistically significant decrease in mid foot pressure during standing from 48.05 kPa pre-operative to 35.30 kPa postoperative, and during walking from 148.08 kPa pre-operative to 90.22 kPa postoperative. A combination of medial displacement calcaneal osteotomy with TCC resection showed statistically significant improvement in VAS and AOFAS scores, as well as decreasing the plantar pressure on the mid foot during standing and walking.

Treatment of Talocalcaneal Coalitions

The purpose of this study was to review outcomes of patients treated for symptomatic talocalcaneal coalition with resection and interposition of fat graft. A retrospective review was performed on all patients who underwent surgical treatment for symptomatic talocalcaneal coalition over a 13-year period. Ninety-three feet were treated with excision and fat graft interposition by 6 surgeons. All patients underwent a chart review. Patient's outcome was assessed at the last follow-up using the American Orthopaedic Foot and Ankle Society Hindfoot scale. Postoperative computed tomography scans were available for 20 feet. Forty-nine feet had follow-up of at least 12 months and had a score obtained through the American Orthopaedic Foot and Ankle Society Hindfoot scale. At an average of 42.6 months of follow-up, the average score obtained was 90/100 (excellent). The postoperative computed tomography scans demonstrated 1 recurrence (3%), which was treated with repeat excision. An additional patient was reoperated for failure to excise the coalition completely. Eleven patients (34%) underwent a subsequent surgery to correct the alignment of the foot. To the best of our knowledge, none of the patients excluded because of short follow-up had repeat surgery or recurrence. A symptomatic talocalcaneal coalition can be treated with excision and fat graft interposition, and achieve good to excellent results in 85% of patients. Patients should be counseled that a subset may require further surgery to correct malalignment. Level IV-case series.

Mid-Term Outcome of Talocalcaneal Coalition Treated with Interposition of a Pedicle Fatty Flap After Resection

We have previously reported a new technique to treat symptomatic talocalcaneal coalition. The purpose of the present study was to evaluate the mid-term outcome of the interposition of a pedicle fatty flap after the resection of a talocalcaneal coalition. Six feet of 5 patients with persistently symptomatic talocalcaneal coalition were treated with this method. We investigated the clinical outcome using the visual analog scale (VAS) for hindfoot pain including around coalition and the American Orthopaedic Foot and Ankle Society (AOFAS) score pre- and postoperatively, and investigated whether or not recurrence was present using computed tomography (CT) at the final followup. The VAS score was significantly improved from 5.5 +/- 1.0 (mean +/- SD) to 9.7 +/- 0.5 points (p = 0.0006). The AOFAS hindfoot score was also improved significantly (from 73.3 +/- 26.7 points to 96.7 +/- 7.1 points). No recurrence was detected by CT at the final followup. The interposition of a pedicle fatty flap after resection has been a durable procedure for treating a symptomatic talocalcaneal coalition.

Arthroscopic Resection of Talocalcaneal Coalitions

Excision of symptomatic talocalcaneal coalitions, after failure of an adequate conservative treatment, is a widely accepted surgical treatment when less than 50% of the subtalar joint is involved and in the absence of degenerative changes to the subtalar or surrounding tarsal joints. Favorable results have been reported in 80% to 100% of patients with open resection. The traditional medial incision to the subtalar joint provides excellent exposure of the middle facet but inadequate visualization of the posterior facet. Other common disadvantages of the traditional open technique include (1) risk of incisional neuroma formation, (2) risk of superficial wound infection and delayed wound healing, and (3) prolonged hospitalization for wound management and pain control. Prone ankle/subtalar arthroscopy has been reported to yield excellent results in the treatment of numerous hindfoot pathologies, with the advantage of reducing postoperative pain, hospital stay, infection rates, wound complications, and recovery time. A posterior arthroscopic technique for posterior-facet talocalcaneal coalition excision has been developed in an attempt to reduce the complications of the traditional open resection. Possible disadvantages of the arthroscopic procedure may include (1) longer learning curve, (2) increased surgical time, (3) possible tibial neurovascular bundle damage, and (4) difficulties in using interposition material.

A 3-portal approach for arthroscopic subtalar arthrodesis

We present a 3-portal approach for arthroscopic subtalar arthrodesis with the patient in the prone position. The prone position allows the use of the two standard posterior portals and it allows for accurate control of hindfoot alignment during surgery. Furthermore, the introduction of talocalcaneal lag screws is easy with the patient in this position. In addition to the standard posterior portals, an accessory third portal is created at the level of the sinus tarsi for introduction of a large diameter blunt trocar to open up the subtalar joint. Due to the curved geometry of the posterior subtalar joint, removal of the anterior articular cartilage is impossible by means of the posterior portals only. An advantage of the 3-portal approach is that ring curettes can be introduced through the accessory sinus tarsi portal to remove the articular cartilage of the anterior part of the posterior talocalcaneal joint. Arthroscopic subtalar arthrodesis in patients with a talocalcaneal coalition presents a technical challenge as the subtalar joint space is limited. The 3-portal technique was successfully used in three subsequent patients with a talocalcaneal coalition; bony union of the subtalar arthrodesis occurred at 6 weeks following surgery. With the 3-portal technique, a safe and time-efficient arthroscopic subtalar arthrodesis can be performed even in cases with limited subtalar joint space such as in symptomatic talocalcaneal coalition.

A Case of Resection of Symptomatic Talocalcaneal Coalition

A Case of Resection of Symptomatic Talocalcaneal Coalition

Surgical management of symptomatic talocalcaneal coalitions by resection of the sustentaculum tali.

Previously described techniques for surgical resection of the subtalar coalitions are technically demanding, with poor outcomes related to incomplete resection and recurrence of the coalition. A new technique, involving complete excision of the involved portion of the sustentaculum tali, has been developed at the authors' institution. A retrospective review of 10 patients with 12 coalitions was performed. The index procedure was performed at an average age of 12.7 years, with a mean follow-up of 5.1 years. Preoperative CT scans obtained to assess the extent of the coalition were analyzed. The AOFAS Hindfoot Questionnaire was used postoperatively to assess the patients' overall outcome and satisfaction with the procedure. Overall, there were eight excellent results and three good results. The postoperative mean AOFAS score was 90 compared with a preoperative score of 46. There have been no recurrences of the coalition or progressive foot malalignment in this series of patients.

Surgical Management of Symptomatic Talocalcaneal Coalitions by Resection of the Sustentaculum Tali

Previously described techniques for surgical resection of the subtalar coalitions are technically demanding, with poor outcomes related to incomplete resection and recurrence of the coalition. A new technique, involving complete excision of the involved portion of the sustentaculum tali, has been developed at the authors' institution. A retrospective review of 10 patients with 12 coalitions was performed. The index procedure was performed at an average age of 12.7 years, with a mean follow-up of 5.1 years. Preoperative CT scans obtained to assess the extent of the coalition were analyzed. The AOFAS Hindfoot Questionnaire was used postoperatively to assess the patients' overall outcome and satisfaction with the procedure. Overall, there were eight excellent results and three good results. The postoperative mean AOFAS score was 90 compared with a preoperative score of 46. There have been no recurrences of the coalition or progressive foot malalignment in this series of patients.

Resection for symptomatic talo-calcaneal coalition

Resection for symptomatic talo-calcaneal coalition

Symptomatic Talocalcaneal Coalition Resection: Indications and Results

We report our results of talocalcaneal coalition (TCC) resection in 25 feet after failed nonoperative treatment. Preoperative computed tomography (CT) scans were used to quantify the amount of heel valgus and the size of the coalition relative to the posterior facet. The ratio of mean TCC cross-sectional area to the surface area of the posterior facet was 53.4%. Mean hindfoot valgus was 17.8 degrees. The mean AOFAS (American Orthopaedic Foot and Ankle Society) hindfoot score was 81.9, at an average of 2.5 years after surgery. Statistical analysis determined a significant association between TCC > 50% the size of the posterior facet and poor outcome (p = 0.014). Similarly, heel valgus > 21 degrees was associated with poor outcome (p = 0.014). However, there were good postoperative results in feet with heel valgus > 21 degrees and in those whose TCC was > 50% of the posterior facet. Therefore we advocate using these CT-scan criteria for preoperative discussions with patients and families and not for determination of the index operative procedure (resection vs. arthrodesis). Hindfoot arthrodesis should only be used as a salvage procedure. We recommend those feet with heel valgus > 21 degrees use an orthosis postoperatively to stabilize the hindfoot or a secondary calcaneal procedure should nonoperative management fail.

Resection for symptomatic talocalcaneal coalition.

Over a 10-year period, 20 persistently symptomatic talocalcaneal tarsal coalitions were treated with resection. These cases were reviewed at an average of 29 months after treatment. Preoperative computed tomography (CT) scans were obtained in 17 of 20 feet. Good or excellent clinical results were obtained in 77% of patients with resection of coalitions involving one third or less of the total joint surface. Increasing age in this group was not a contraindication to surgery. Four patients had an uncommon varus deformity and were treated with resection. Overall this subgroup had a poorer prognosis.

Resection for Symptomatic Talocalcaneal Coalition

Resection for Symptomatic Talocalcaneal Coalition

Talocalcaneal Coalition Resection: A 10-Year Follow-up

Eight patients (nine feet) who underwent resection of persistently symptomatic talocalcaneal middle-facet coalitions were reevaluated > or = 10 years after surgery. Satisfactory results persisted in eight of nine cases with no deterioration of symptom relief. There was no loss of motion or development of degenerative joint changes. No patient required a secondary surgery. It appears that resection of symptomatic talocalcaneal coalition provides satisfactory results in the majority of patients, and its benefits are maintained 10 years after the procedure.

Resection for symptomatic talocalcaneal coalition

Over a nine-year period, 20 feet with persistently symptomatic talocalcaneal coalition were treated by resection of the bar. The 17 patients were all under 16 years of age. Excellent or good long-term results were achieved in the ten feet in which preoperative coronal CT had shown that the area of coalition measured 50% or less of the area of the posterior facet of the calcaneum. In these feet heel valgus was less than 16 degrees and there were no radiographic signs of arthritis of the posterior talocalcaneal joint. Talar beaking was present in 70% of these feet but it did not impair the clinical result. Fair or poor results were observed in the ten feet in which preoperative CT had shown the area of relative coalition to be greater than 50%. In these feet, heel valgus was greater than 16 degrees and most had narrowing of the posterior talocalcaneal joint and impingement of the lateral process of the talus on the calcaneum.