Tarsal Coaliltion

- See:
        - Talocalcaneal Coalition
        - Calcaneonavicular Coalition

- Discussion:
    - coalition between tarsal bones is frequent cause of painful flatfoot (pes planus) in the older child or adolescent;
          - tarsal coalition may be osseous, cartilaginous, or fibrous.
    - calcaneonavicular coalition bar is most common, followed by middle facet of talocalcaneal coalition joint;
          - single coalition is most common, > one are occassionally found
    - there is a tendency to progressive ossification of bar w/ increasing age, and this often corresponds with the onset of symptoms;
          - ossification occurs at 8 - 12 yrs for calcaneonavicular bars and between 12 - 15 years for talocalcaneal coalitions.
    - ankle sprain are common;
    - autosomal dominance w/ variable penetrance is mechanism of inheritance;
    - majority of tarsal coalitions are asymptomatic, & evidence indicates that they remain so in adulthood;
    - symptomatic lesions often are treated initially by immobilization for three to six weeks, followed by an orthosis;

- Exam:
    - painful flat foot, limitied subtalar movement, and tenderness in subtalar area;
    - valgus heel and everted forefoot w/ limited sub talar motion
    - w/ progressive restriction of motion in the sub-talar joint, compensatory movement occurs at ankle, leading to ligamentous laxity;
    - subtalar motion is decr, esp for talocalcaneal bar, & rigid flatfoot w/ contracture of peroneal tendons (peroneal spastic flatfoot) exists;
    - pain in subtalar or midtarsal area often develops in early adolescence & is typically relieved by rest;
         - restricted subtalar motion leads to spasm of peroneal muscles, hence the term "peroneal spastic flatfoot."
    - patients are often unable to stand on lateral aspect of foot;

- Radiographic Studies:
    - radiographic features of talocalcaneal coalition;
    - radiographic features of calcaneonavicular coalition:
         - lateral view:
                  - often has signs suggestive of coalition:
                  - blunting of subtalar process, elongation of anteior calcaneal process, narrowing of posterior subtalar joint, & talar beaking;

- Non Operative Treatment:
    - asymptomatic coalition does not require surgical treatment;
    - orthotic objectives:
    - reduce subtalar motion or stresses;
    - reduce medial-lateral hindfoot forces;
    - UCBL
    - total contact orthosis supporting subtalar joint;
    - high top for medial lateral stability;

- Indications for Surgery:
    - talocalcaneal coalition
    - calcaneonavicular coalition
    - for symptomatic coalition before degenerative changes have occured usually in pts under age of 14 years), resection is
            usual treatment;
    - this procedure is not appropriate if cartilagenous bar is completely ossified and degenerative changes have occurred or if coalition
            between the talus and calcaneus is also present;
    - in pts over age of 14, who have degenerative changes, a below knee, wt bearing cast, a plastizoate insert for the shoe, or an AFO
            may relieve the pain;
            - failure to respond to these conservative measures & presence of degenerative changes indicate the need for triple arthrodesis

Subtalar fusion for isolated subtalar disorders. Preliminary report.

Resection as a method of treatment of tarsal coalitions

The inheritance of tarsal coalition and its relationship to spastic flat foot.

Tarsal coalitions: long-term results of surgical treatment.

Surgical management of tarsal coalition in adolescent athletes.

Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Tuesday, September 20, 2016 5:30 am