SLR - August 2012 - Kyle S. Peterson
Reference: Gantsoudes GD, Roocroft JH, Mubarak SJ. (2012). Treatment of Talocalcaneal Coalitions. J Pediatr Orthop, 32(3), 301-307.
Scientific Literature Review
Reviewed by: Kyle S. Peterson, DPM
Residency Program: The Western Pennsylvania Hospital, Pittsburgh, PA
Podiatric Relevance:
Foot and ankle surgeons commonly encounter patients presenting with rigid flatfeet. One common cause of a rigid flatfoot in a pediatric patient is a tarsal coalition. Talocalcaneal and calcaneonavicular coalitions represent the two most common types. These authors report a retrospective review of patients treated with resection and interposition of fat graft for symptomatic talocalcaneal coalitions.
Methods:
A retrospective review from 1996 to 2009 was performed identifying 102 feet in 81 patients that were treated with talocalcaneal coalition resection and fat graft interposition. Following exclusion criteria, 49 feet in 32 patients were identified for inclusion in the study. All of the surgeries were performed in the same manner by six different surgeons. Patient’s outcomes were assessed by the American Orthopaedic Foot and Ankle Society (AOFAS) Hindfoot scale with a minimum of 12 months follow-up. Twenty-five of the 49 feet also had postoperative CT scans to evaluate the status of the coalition.
Results:
The average age at the time of surgery was 13.1 years. At an average follow-up of 42.6 months, the average AOFAS Hindfoot score was 90 out of 100. One foot (2 percent) had a poor outcome, 6 (12 percent) had fair outcomes, 10 (20 percent) had good outcomes, and 32 (64 percent) had excellent outcomes. Eleven of the 49 feet (22 percent) underwent a total of 12 secondary surgical procedures, including 2 revisional surgeries (4 percent) for a recurrence and failure of adequate resection of coalition. All of these secondary procedures also included staged correction for a pes valgus deformity. The average AOFAS score for the patients undergoing secondary procedures was 87.75. In addition to the two revisional surgeries, one complication of a wound granuloma was encountered, requiring a wound debridement. Finally, they subdivided their patients into those with follow-up of < 24 months, follow-up between two and four years, and follow-up > four years. The mean AOFAS scores of these groups were 93.3, 86.8, 89.9, respectively (P=0.32).
Conclusions:
These authors found 85 percent good to excellent results following surgical excision and fat graft interposition for symptomatic talocalcaneal coalitions in a pediatric population. The authors note these results compare favorably and even exceed those of patients undergoing fusions. In addition, they recommend staged surgical procedures when patients present with symptomatic coalitions and concomitant hindfoot valgus. Overall, the authors conclude that excision of coalitions is the best solution to prevent future pathology and to relieve pain and improve range of motion.