Review ArticleA Review of Tarsal Coalition and Pes Planovalgus: Clinical Examination, Diagnostic Imaging, and Surgical Planning
Section snippets
Clinical Examination
The patient with a frank osseous coalition commonly presents with a rigid pes planovalgus foot type, with or without peroneal spasm. This condition generally starts as a painless decrease in the range of motion of a joint and progresses to a symptomatic rigid deformity. Patients often complain of “ankle pain” that is aggravated with activity, or have a history of recent or recurrent ankle sprains (7). TC coalitions usually become symptomatic around the ages of 12 to 16, which correlates with
Clinical Examination
Whereas the clinical presentation and diagnostic imaging findings of the osseous TC coalition have been discussed, the more commonly encountered deformity is the collapsing pes planovalgus foot type, which remains flexible and is free of any arthritic changes. These 2 conditions differ dramatically with regard to clinical and radiographic findings. Collapsing pes planovalgus patients rarely complain of “ankle pain,” as seen in children with coalitions, and more commonly complain of pain along
The “Gray Zone”
The 2 types of patients discussed thus far, those with rigid coalition flatfoot and those with flexible pes planovalgus foot, represent opposing ends of the spectrum of painful pediatric flatfoot deformities, and the diagnoses are readily discernable with routine clinical and radiographic examinations. However, many patients have signs and symptoms that lie somewhere in between these 2 extremes, making an accurate diagnosis more challenging. There are patients with coalitions that have not yet
The Role of Diagnostic Imaging
Plain-film radiographs and CT will help to delineate the etiology in the rigid painful foot, whether it is arthritic or a coalition. Most importantly, this information will guide the surgical treatment plan. Radiographs are screening tools and are rarely totally diagnostic alone, with the exception of the CN coalition. A severely arthritic pes planovalgus foot may have changes similar to those observed in the foot with a TC coalition. A severely pronated STJ can obscure the visibility of the
Surgical Planning for Tarsal Coalition
The information gained in diagnostic imaging of coalitions assists in developing a surgical plan that is individualized to the patient based on age, clinical findings, and imaging characteristics. Two general surgical options include coalition resection and fusion, with or without adjunctive reconstructive procedures to address pes planovalgus and/or equinus. In the authors' experience, a CN coalition responds better to resection than a TC coalition and, in general, a coalition resection,
Conclusions
In conclusion, the pediatric pes planovalgus deformity encompasses the flexible deformity, the osseous coalition, and everything in between. Algorithms exist to help establish guidelines for surgeons in the diagnosis and treatment of these disorders 1, 58, 59. Although these can be helpful, they provide vague direction when a patient presents somewhere in between the flexible pes planovalgus and the frank osseous coalition. Tarsal coalitions are far from black-and-white disorders. The authors
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Cited by (59)
Tarsal Coalitions
2022, Clinics in Podiatric Medicine and SurgerySurgical Treatment of Calcaneonavicular and Talocalcaneal Coalitions
2021, Foot and Ankle ClinicsCitation Excerpt :According to Lee and colleagues21 who reviewed radiological findings, CT and MRI images in 43 feet affected by TCC, the typical C-sign, which is generally present in middle facet coalitions, was present in only 32% of the TCC cases; in 68%, the posterior facet was involved, and a “deformed C-sign” was described. CT technique should be performed perpendicular to the subtalar joint (“coalition-specific axial plane”) to permit a better visualization of the facets and with 1.0 × 1.0-mm slices.14 In a retrospective study, ultrasound appearance of TCC was studied.
The natural course of pain in patients with symptomatic tarsal coalitions: A retrospective clinical study
2020, Foot and Ankle SurgeryMusculoskeletal Podiatric Medicine
2020, Neale’s Disorders of the Foot and AnkleRealignment Calcaneal Osteotomy for Bilateral Complete Talocalcaneal Synostosis: A Case Report
2019, Journal of Foot and Ankle SurgeryPost-operative outcomes of arthroscopic tarsal coalition resection: A systematic review
2020, Journal of OrthopaedicsCitation Excerpt :TCC are the second most frequent tarsal coalitions. Patients commonly present with medial ankle pain exacerbated by physical activity and a flat foot deformity.6 Non-operative interventions such as activity modification, nonsteroidal anti-inflammatories, orthotics, or immobilisation in a walking boot or a short leg cast are the first-line treatment options for symptomatic coalitions.7
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Conflict of Interest: None reported.