Advanced Learning Pathway: Pediatrics 2 – Tarsal Coalition, Congenital Vertical Talus, Flexible Flatfoot, Clubfoot

Learning Objectives of this Pathway:

• Describe the indications for resection of a tarsal coalition.
• Describe the outcomes for resected tarsal coalitions and how this informs the consent process.
• Explain appropriate treatment options for congenital vertical talus.
• Differentiate between various flexible and rigid pediatric flatfoot conditions.
• Explain appropriate treatment options for flexible pediatric flatfoot deformities including congenital calcaneovalgus and acquired pediatric flatfoot.
• Describe the principles in management of congenital talipes equinovarus (clubfoot).

Download a PDF of this learning pathway

Day 1: Tarsal Coalition

Clinical Sessions:
Tarsal Coalitions

JFAS Articles:

• A Review of Tarsal Coalition and Pes Planovalgus: Clinical Examination, Diagnostic Imaging, and Surgical Planning
• Diagnosis and Treatment of Pediatric Flatfoot (NOTE: covers flexible flatfoot, congenital vertical talus, tarsal coalition, iatrogenic/postraumatic, skewfoot, etc.)
• Functional and Radiological Outcomes After Tarsal Coalition Resections: A Minimum of 5-Year Follow-Up
• Reoperations After Tarsal Coalition Resection: A Population-Based Study
• Subtalar Coalitions: Does the Morphology of the Subtalar Joint Involvement Influence Outcomes After Coalition Excision?
• Calcaneonavicular Coalition Resection with Pes Planovalgus Reconstruction
• Resection Arthroplasty: Treatment for Calcaneonavicular Coalition

Outside Journals and Books:

• Rodriguez N, Choung DJ, Dobbs MB. “Rigid pediatric pes planovalgus: conservative and surgical treatment options Clin Podiatr Med Surg 2010; 27:79-92.
• Furdon, SA, Donlon CR. “Examination of the newborn foot: positional and structural abnormalities.”Advanc Neonatal Care 2002; 2(5):248-258.
• Sankar WN, Weiss J, Skaggs DL. “Orthopaedic conditions in the newborn.”J Am AcadOrthop Surg 2009; 17:112- 122.

Surgical Techniques e-Learning:

• Common Foot & Ankle Procedures (online format)| Kidner Procedure
• Common Foot & Ankle Procedures (online format)| Gastrocnemius Recession Distal
• Rearfoot Reconstruction (online format)| Tendon Achilles Lengthening
• Rearfoot Reconstruction (online format)| Medial Approach Double Arthrodesis (NOTE: watch from time stamp 5:46 to 9:02 for medial incision dissection used in STJ middle facet coalition resections.)
• Rearfoot Reconstruction (online format)| Medial Calcaneal Displacement Osteotomy
• Rearfoot Reconstruction (online format)| Gastrocnemius Recession (proximal)
• Rearfoot Reconstruction (online format)| Talonavicular Joint Arthrodesis (NOTE: watch time stamps from 8:55 to 11:03 for landmarks and soft tissue structures of medial incision approach along medial column used in some flatfoot procedures.)

Podcasts:
Arthroeresis: Too Much or Not Enough?

JFAS Articles:

• Diagnosis and Treatment of Pediatric Flatfoot (NOTE: covers flexible flatfoot, congenital vertical talus, tarsal coalition, iatrogenic/postraumatic, skewfoot, etc.
• Flexible Juvenile Flatfoot Surgical Correction: A Comparison Bewteen Two Techniques After Ten Years’ Experience
• Symptomatic Juvenile Flatfoot Condition: Surgical Treatment

Outside Journals and Books:

• David, MS., and Weinraub, GM (2020). Calcaneovalgus and Congenital Vertical Talus. In M.L. Butterworth and J.T. Marcoux (1^stEd.),The Pediatric Foot and Ankle: Diagnosis and Management.(Chapter 9). Basel, Switzerland: Springer.
• Mahan KT, Flanigan KP. (2013). Flexible Valgus Deformity. In J.T.Southerland (4^thEd.),McGlamry's Comprehensive Textbook of Foot and Ankle Surgery(Chapter 44). Philadelphia, PA: Lippincott Williams & Wilkins.
• Evan, A. (2008) Flatfoot child treatment. J American Pod Med Assoc98(5):386-393.
• Halabchi et al. (2013) Pediatric flexible flatfeet clinical aspects and algorithimic approaches. Iran J Pediatrics 23(3):254-256.
• Kwon, JY and Myerson, MS. (2010) Management of the flexible flatfoot in the child: a focus on the use of osteotomies for correction.Foot Ankle Clin N America15:309-322.
• Pfieffer, M et al (2006) Prevalence of flatfoot in the preschool aged children.Pediatric.188: 634-639.
• Sullivan, J. (1999) Pediatric flatfoot evaluation and management.J of American AcadOrthop Surg7:44-53.

Day 3: Clubfoot

Clubfoot

The Natural History and Longitudinal Study of the Surgically Corrected Clubfoot

Outside Journals and Books:

• Staheli, L. Clubfoot Ponseti Management 3^rdEdition. Global HELP Organization, 2009.
• Cicchineli, LD., et al (2013). Clubfoot. In J.T. Southerland (4^thEd.),McGlamry's Comprehensive Textbook of Foot and Ankle Surgery(Chapter 74). Philadelphia, PA: Lippincott Williams & Wilkins.
• Hatch, DJ (2020). Congenital Talipes Equinovarus. In M.L. Butterworth and J.T. Marcoux (1^stEd.),The Pediatric Foot and Ankle: Diagnosis and Management.(Chapter 12). Basel, Switzerland: Springer.
• Cummings RJ, et al. “Congenital clubfoot.”AAOS InstrucCoursLect2002; 51:385-400.
• Coplan J and Herzenberg J (2010). Non-Operative Treatment of Congenital Clubfoot. InDrennan’s The Child’s Foot & Ankle (2nd Ed.) McCarthy and Drennan editors, Lippincott Williams & Wilkins: p.64-74.-74.
• Dobbs MB, et al. “Treatment of idiopathic clubfoot: an historical review.”Iowa Orthop J 2000; 20:50-64.
• Dobbs M, et al. Factors Predictive of Outcome After Use of the Ponseti Method for the Treatment of Idiopathic Clubfeet. JBJS, Jan 2004; 86-A (1): 22-27.
• McCauley JC. “Clubfoot: history of the development and the concepts of pathogenesis and treatment.”Clin Orthop Rel Res 1966: 51-63.
• Morcuende J, et al. Radical Reduction in the Rate of Extensive Corrective Surgery for Clubfoot Using the Ponseti Method. Pediatrics, Feb 2004; 113(2): 376-380.
• Parker SE, et al. “Multistate study of the epidemiology of clubfoot.”Birth Defects Res Part A: Clin Mol Terat2009; 85:897-904.
• Ponsetti, Igancio V. Congenital clubfoot: Fundamentals of treatment (1996) Oxford University Press Inc., New York, N.Y.
• Radler C, et al. Radiographic Evaluation of Idiopathic Clubfeet Undergoing Ponseti Treatment, JBJS, June 2007; 89-A (6): 1177-1183.
• Roye DP, Roye BD. “Idiopathic congenital talipes equinovarus.”J Am AcadOrthop Surg 2002; 10:239-248.
• Thompson , et al. Surgical management of resistant congenital talipes equinovarus deformities, JBJS, 1982; 64-A: 652-665.
• Turco, Vincent J. Clubfoot (1981) Churchill Livingstone Inc., New York, N.Y.

The ACFAS learning pathways are a tool to be used by residency directors, fellowship directors and school faculty to aid with didactic learning during the COVID-19 crisis. They are not intended to replace a curriculum, but to supplement student and resident education during this time of need. The learning pathways are divided into basic, intermediate, and advanced categories. Pathways have been organized into specific topics that have a variety of educational materials from the ACFAS On Demand course content. They also include journal articles with links primarily from The Journal of Foot & Ankle Surgery (JFAS).