Symptomatic talocalcaneal coalition resection: indications and results

Area of Science:

• Orthopaedic Surgery
• Foot and Ankle Reconstruction
• Biomechanical Analysis

Background:

• Talocalcaneal coalition (TCC) is a challenging condition often requiring surgical intervention.
• Nonoperative treatments frequently fail, necessitating further management.
• Preoperative assessment is crucial for determining optimal surgical strategy.

Purpose of the Study:

• To evaluate the outcomes of talocalcaneal coalition resection.
• To identify predictive factors for surgical success using computed tomography (CT) criteria.
• To guide preoperative decision-making regarding surgical approach.

Main Methods:

• Retrospective analysis of 25 feet undergoing TCC resection after failed conservative care.
• Preoperative CT scans assessed heel valgus and TCC size relative to the posterior facet.
• American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot scores evaluated outcomes at an average of 2.5 years post-surgery.

Main Results:

• Mean TCC size was 53.4% of the posterior facet; mean hindfoot valgus was 17.8 degrees.
• A significant association was found between TCC > 50% and heel valgus > 21 degrees with poor outcomes (p = 0.014).
• Despite these associations, good postoperative results were observed in feet with significant TCC or heel valgus.

Conclusions:

• CT-derived criteria for TCC size and heel valgus are valuable for preoperative patient counseling.
• These criteria should not solely dictate the choice between resection and arthrodesis.
• Hindfoot arthrodesis is best reserved for salvage procedures; orthotic or secondary calcaneal procedures may be considered for persistent hindfoot instability.