Talocalcaneal Coalition Resection with Local Fat Grafting and Flatfoot Reconstruction

Area of Science:

• Orthopedic Surgery
• Pediatric Orthopedics
• Foot and Ankle Surgery

Background:

• Talocalcaneal (TC) coalitions commonly affect children, causing hindfoot/ankle pain and limited subtalar motion.
• Standard treatment for isolated coalitions is resection with fat interposition.
• Patients with concurrent rigid flatfoot require additional reconstructive procedures.

Purpose of the Study:

• To describe a surgical technique combining TC coalition resection with local fat grafting and flatfoot reconstruction.
• To address the challenge of treating TC coalitions in pediatric patients with concomitant rigid flatfoot deformity.

Main Methods:

• The described technique involves three main steps: gastrocnemius recession/fat harvesting, TC coalition resection with fat interposition, and peroneus brevis Z-lengthening with calcaneal lateral column lengthening osteotomy using allograft.
• Specific surgical steps include meticulous dissection, coalition resection, fat grafting, osteotomy, and tendon repair.
• Key technical considerations involve protecting neurovascular structures and ensuring proper allograft placement.

Main Results:

• This combined approach aims to correct both the coalition and the flatfoot deformity.
• Expected outcomes include improved subtalar motion, correction of flatfoot, and enhanced hindfoot alignment.
• Patients typically experience improved pain and function following the procedure.

Conclusions:

• This surgical technique offers a comprehensive solution for pediatric patients with talocalcaneal coalition and rigid flatfoot.
• It addresses the limitations of coalition resection alone in correcting associated flatfoot deformities.
• The procedure is expected to lead to significant improvements in patient satisfaction, range of motion, and functional outcomes.