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Talocalcaneal tarsal coalitions and the calcaneal lengthening osteotomy: the role of deformity correction.
J Bone Joint Surg Am. 2012 Sep 05; 94(17):1584-94.JB

Abstract

BACKGROUND

Surgical resection of persistently painful talocalcaneal tarsal coalitions may not reliably relieve symptoms in patients with large coalitions associated with excessive hindfoot valgus deformity and subtalar posterior facet narrowing. Since 1991, calcaneal lengthening osteotomy, with or without coalition resection, has been used at our institution to relieve symptoms and to preserve motion at the talonavicular and calcaneocuboid joints.

METHODS

We retrospectively reviewed the records for eight patients with thirteen painful talocalcaneal tarsal coalitions who had undergone a calcaneal lengthening osteotomy for deformity correction with or without coalition resection between 1991 and 2005. Preoperative and postoperative clinical, radiographic, and computed tomographic records were reviewed. The duration of clinical follow-up ranged from two to fifteen years.

RESULTS

Calcaneal lengthening osteotomy fully corrected the valgus deformity and provided short-to-intermediate term pain relief for the five patients (nine feet) in whom the talocalcaneal tarsal coalition was unresectable. The patient with resectable coalitions but excessive valgus deformities underwent calcaneal lengthening osteotomies along with coalition resections and had excellent deformity correction and pain relief in both feet. One of the two patients who underwent calcaneal lengthening osteotomy years after coalition resection had excellent correction and pain relief. The other patient had a coincident calcaneonavicular coalition and severe degenerative arthritis in the talonavicular joint. He underwent concurrent arthrodesis of the talonavicular joint and, although he had excellent deformity correction, had persistent pain. All feet underwent concurrent gastrocnemius or Achilles tendon lengthening.

CONCLUSIONS

It is generally accepted that resection is the treatment of choice for an intractably painful small talocalcaneal tarsal coalition that is associated with a wide, healthy posterior facet and minimal valgus deformity of the hindfoot. Although triple arthrodesis has been recommended for those who do not meet all three criteria, the present study suggests that an algorithmic treatment approach is justified. Treatment of the valgus deformity appears to be as important as that of the coalition. Calcaneal lengthening osteotomy with gastrocnemius or Achilles tendon lengthening is effective for correcting deformity and relieving pain in rigid flatfeet, just as it is in flexible flatfeet.

Authors+Show Affiliations

Department of Orthopaedics, Seattle Children's Hospital, Seattle, WA 98105, USA. vincent.mosca@seattlechildrens.orgNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

22992849

Citation

Mosca, Vincent S., and Wesley P. Bevan. "Talocalcaneal Tarsal Coalitions and the Calcaneal Lengthening Osteotomy: the Role of Deformity Correction." The Journal of Bone and Joint Surgery. American Volume, vol. 94, no. 17, 2012, pp. 1584-94.
Mosca VS, Bevan WP. Talocalcaneal tarsal coalitions and the calcaneal lengthening osteotomy: the role of deformity correction. J Bone Joint Surg Am. 2012;94(17):1584-94.
Mosca, V. S., & Bevan, W. P. (2012). Talocalcaneal tarsal coalitions and the calcaneal lengthening osteotomy: the role of deformity correction. The Journal of Bone and Joint Surgery. American Volume, 94(17), 1584-94.
Mosca VS, Bevan WP. Talocalcaneal Tarsal Coalitions and the Calcaneal Lengthening Osteotomy: the Role of Deformity Correction. J Bone Joint Surg Am. 2012 Sep 5;94(17):1584-94. PubMed PMID: 22992849.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Talocalcaneal tarsal coalitions and the calcaneal lengthening osteotomy: the role of deformity correction. AU - Mosca,Vincent S, AU - Bevan,Wesley P, PY - 2012/9/21/entrez PY - 2012/9/21/pubmed PY - 2012/12/10/medline SP - 1584 EP - 94 JF - The Journal of bone and joint surgery. American volume JO - J Bone Joint Surg Am VL - 94 IS - 17 N2 - BACKGROUND: Surgical resection of persistently painful talocalcaneal tarsal coalitions may not reliably relieve symptoms in patients with large coalitions associated with excessive hindfoot valgus deformity and subtalar posterior facet narrowing. Since 1991, calcaneal lengthening osteotomy, with or without coalition resection, has been used at our institution to relieve symptoms and to preserve motion at the talonavicular and calcaneocuboid joints. METHODS: We retrospectively reviewed the records for eight patients with thirteen painful talocalcaneal tarsal coalitions who had undergone a calcaneal lengthening osteotomy for deformity correction with or without coalition resection between 1991 and 2005. Preoperative and postoperative clinical, radiographic, and computed tomographic records were reviewed. The duration of clinical follow-up ranged from two to fifteen years. RESULTS: Calcaneal lengthening osteotomy fully corrected the valgus deformity and provided short-to-intermediate term pain relief for the five patients (nine feet) in whom the talocalcaneal tarsal coalition was unresectable. The patient with resectable coalitions but excessive valgus deformities underwent calcaneal lengthening osteotomies along with coalition resections and had excellent deformity correction and pain relief in both feet. One of the two patients who underwent calcaneal lengthening osteotomy years after coalition resection had excellent correction and pain relief. The other patient had a coincident calcaneonavicular coalition and severe degenerative arthritis in the talonavicular joint. He underwent concurrent arthrodesis of the talonavicular joint and, although he had excellent deformity correction, had persistent pain. All feet underwent concurrent gastrocnemius or Achilles tendon lengthening. CONCLUSIONS: It is generally accepted that resection is the treatment of choice for an intractably painful small talocalcaneal tarsal coalition that is associated with a wide, healthy posterior facet and minimal valgus deformity of the hindfoot. Although triple arthrodesis has been recommended for those who do not meet all three criteria, the present study suggests that an algorithmic treatment approach is justified. Treatment of the valgus deformity appears to be as important as that of the coalition. Calcaneal lengthening osteotomy with gastrocnemius or Achilles tendon lengthening is effective for correcting deformity and relieving pain in rigid flatfeet, just as it is in flexible flatfeet. SN - 1535-1386 UR - https://www.unboundmedicine.com/medline/citation/22992849/Talocalcaneal_tarsal_coalitions_and_the_calcaneal_lengthening_osteotomy:_the_role_of_deformity_correction_ L2 - http://dx.doi.org/10.2106/JBJS.K.00926 DB - PRIME DP - Unbound Medicine ER -