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Resection for symptomatic talocalcaneal coalition

P H Wilde1, I P Torode, D R Dickens

  • 1Royal Children's Hospital, Melbourne, Australia.

The Journal of Bone and Joint Surgery. British Volume
|September 1, 1994
PubMed
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Resecting talocalcaneal coalition bars in young patients yielded good results when the coalition was less than 50% of the posterior facet. Larger coalitions (>50%) correlated with poorer outcomes in this surgical treatment study.

Area of Science:

  • Orthopedic surgery
  • Pediatric orthopedics
  • Foot and ankle surgery

Background:

  • Talocalcaneal coalition is a congenital condition causing foot pain and limited motion, often presenting in adolescents.
  • Surgical resection of the coalition bar is a common treatment for symptomatic talocalcaneal coalition.
  • Predicting surgical outcomes in pediatric talocalcaneal coalition remains an area of interest.

Purpose of the Study:

  • To evaluate the long-term outcomes of surgical resection for symptomatic talocalcaneal coalition in pediatric patients.
  • To identify preoperative radiographic factors that predict successful surgical outcomes.

Main Methods:

  • A retrospective review of 20 feet from 17 patients under 16 years of age treated for talocalcaneal coalition by bar resection over nine years.

Related Experiment Videos

  • Preoperative coronal CT scans were used to quantify the area of coalition relative to the posterior facet of the calcaneum.
  • Clinical outcomes were assessed, and radiographic parameters including heel valgus and posterior talocalcaneal joint arthritis were evaluated.

    • Main Results:

    • Excellent or good long-term results were achieved in 10 feet where coalition measured ≤50% of the posterior facet area, with heel valgus <16 degrees and no arthritis.
    • Fair or poor results were observed in 10 feet where coalition measured >50% of the posterior facet area, often associated with heel valgus >16 degrees and joint narrowing.
    • Talar beaking was present in 70% of feet with good outcomes but did not negatively impact the clinical result.

    Conclusions:

    • Preoperative CT assessment of coalition size is a valuable predictor of surgical success in talocalcaneal coalition resection.
    • Resection of talocalcaneal coalition bars can provide good to excellent long-term results, particularly when the coalition is less extensive and associated with minimal heel valgus and joint degeneration.
    • Surgical intervention for extensive talocalcaneal coalition may yield less favorable outcomes due to associated biomechanical abnormalities.