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Tarsal coalition in paediatric patients.

Pierre-Louis Docquier1, Pierre Maldaque2, Maryse Bouchard3

  • 1Orthopaedic surgery and traumatology department, Saint-Luc university hospital, 10, avenue Hippocrate, 1200 Brussels, Belgium.

Orthopaedics & Traumatology, Surgery & Research : OTSR
|March 31, 2018
PubMed
Summary

Tarsal coalition, a foot bone fusion, causes pain during activity. Non-operative treatment is tried first, with surgery like resection considered if pain persists.

Keywords:
Calcaneo-navicular coalitionSynchondrosisSyndesmosisSynostosisTalo-calcaneal coalitionTarsal coalition

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Area of Science:

  • Orthopedics
  • Embryology
  • Radiology

Background:

  • Tarsal coalition is a congenital abnormality resulting from incomplete separation of foot bones during embryonic development.
  • It can manifest as syndesmosis, synchondrosis, or synostosis, with talo-calcaneal and calcaneo-navicular types being most common (over 90%).
  • Symptoms often include activity-related pain and stiffness, typically emerging in the second decade of life.

Purpose of the Study:

  • To review the pathophysiology, clinical presentation, diagnostic methods, and management of tarsal coalition.
  • To emphasize the importance of non-operative management and surgical options for symptomatic cases.

Main Methods:

  • Review of existing literature on tarsal coalition.
  • Discussion of diagnostic imaging techniques including radiography, CT, and MRI.
  • Analysis of treatment strategies, encompassing non-operative measures and surgical interventions.

Main Results:

  • Tarsal coalition leads to a stiffened joint, often presenting with pain during physical activity or recurrent ankle sprains.
  • Physical examination may reveal limited hindfoot/midfoot motion and malalignment; imaging is crucial for diagnosis.
  • Non-operative management for at least six months is the recommended initial approach for symptomatic patients.

Conclusions:

  • Surgical intervention, such as coalition resection (open or endoscopic), is indicated when non-operative treatments fail.
  • Resection offers favorable long-term outcomes, while fusion is reserved for complex cases or treatment failures.
  • Early diagnosis and appropriate management are key to improving patient outcomes for tarsal coalition.