Subtalar Coalitions in the Adult

Flynn, James; Wukich, Dane K.; Conti, Stephen F.; Hasselman, Carl T.; Hogan, MaCalus V.; Kline, Alex J.

doi:10.1016/j.fcl.2015.02.010

Cited by 8 publications

(3 citation statements)

References 45 publications

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“…• Patient age between 9 and 16 years is ideal. For patients .16 years, the decision must be made on the basis of the rigidity of the hindfoot [1][2][3][4][5] .…”

Section: Indications and Contraindications Indicationsmentioning

confidence: 99%

Excision of a Middle Facet Tarsal Coalition

Li¹,

Myerson²

2020

JBJS Essential Surgical Techniques

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Background: Middle facet tarsal coalition is one of the commonly seen tarsal coalitions in clinical practice that can cause pain and associated flatfoot deformity. Excision of the coalition is one of the treatment options for symptomatic cases. Although symptoms may subside in children following a period of immobilization, resection should be considered as a treatment alternative for children and adolescents because of the potential for restoration of subtalar joint movement. The indications for excision of the coalition are not consistently reported in the literature, and the procedure is not always easy to perform. In this article, we describe the steps for a successful excision of a middle facet tarsal coalition. Description: The incision is marked from 1 cm inferior to the medial malleolus, extending distally to the navicular tuberosity and inferior to the level of the posterior tibial tendon. The coalition is first located by retracting the flexor tendons and the neurovascular bundle. The bone on the surface of the coalition is gradually removed to expose the middle facet. A 2-mm guide pin and a cannulated dilator probe inserted through the sinus tarsi into the tarsal canal that exits anterior to the posterior facet help with identifying the margins of the coalition. The middle facet is then removed either partially or totally, depending on the size, shape, and location of the coalition, until the posterior facet is visualized. Following excision, bone wax is used on the exposed surfaces or fat is inserted to prevent adhesion and recurrent bone formation. If there is an associated flatfoot deformity, additional surgeries, including a medial translational osteotomy or a lateral column lengthening of the calcaneus, a Cotton osteotomy, an arthroereisis, or a calcaneus stop procedure, may be necessary. Alternatives: The alternative treatment for managing a middle facet coalition is immobilization of the foot in a boot or cast for 6 to 8 weeks to decrease pain. This will not improve the function of the hindfoot, which remains stiff, but may alleviate pain temporarily. Excision of the coalition in combination with other procedures for correction of the flatfoot is an alternative to an arthrodesis of the subtalar joint and works well in children and adolescents, particularly in those with reasonable subtalar joint flexibility. A triple arthrodesis is rarely Disclosure: The authors indicated that no external funding was received for any aspect of this work. The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSEST/A285).

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“…• Patient age between 9 and 16 years is ideal. For patients .16 years, the decision must be made on the basis of the rigidity of the hindfoot [1][2][3][4][5] .…”

Section: Indications and Contraindications Indicationsmentioning

confidence: 99%

Excision of a Middle Facet Tarsal Coalition

Li¹,

Myerson²

2020

JBJS Essential Surgical Techniques

View full text Add to dashboard Cite

show abstract

“…Plain radiographs are first line for evaluation, but direct visualization is difficult because of the complex anatomy of the joint. 3,4 Computed tomography has a limited ability to assess adjacent soft tissues.…”

mentioning

confidence: 99%

“…Patients may present with rigid pes planus and medial foot pain during periods of increased physical activity. Plain radiographs are first line for evaluation, but direct visualization is difficult because of the complex anatomy of the joint 3,4 . Computed tomography has a limited ability to assess adjacent soft tissues.…”

mentioning

confidence: 99%