Surgical treatment of tarsal coalitions in children and adolescents

Abstract

A tarsal coalition is an abnormal connection between two or more tarsal bones caused by failure of mesenchymal segmentation. The two most common tarsal coalitions are calcaneonavicular coalition (CNC) and talocalcaneal coalition (TCC). Both CNC and TCC can be associated with significant foot and ankle pain and impaired quality of life; there may also be concomitant foot and ankle deformity. Initial, non-operative management for symptomatic tarsal coalition commonly fails, leaving surgical intervention as the only recourse. The focus of this article is to critically describe the variety of methods used to surgically manage CNC and TCC. In review of the pertinent literature we highlight the ongoing treatment controversies in this field and discuss new innovations. The evidence-based algorithmic approach used by the authors in the management of tarsal coalitions is illustrated alongside some clinical pearls that should help surgeons treating this common, and at times complex, condition. Cite this article: EFORT Open Rev 2020;5:80-89. DOI: 10.1302/2058-5241.5.180106

Calcaneonavicular coalition resection

“…A historical report from Mitchell and Gibson, who undertook resection without interposition, demonstrated a recurrence rate of 66% (1) . In response to those results, Mubarak et al (14) conducted a retrospective study that found good results using autogenous fat as an interposition graft, showing lower rates of reossification and reoperation compared with the use of extensor digitorum brevis as interposition graft.…”

“…Tarsal coalition is a term used to define an abnormal connection between two tarsal bones, was officially described for the first time by Buffon in 1796, and is caused by failure of mesenchymal segmentation during embryogenesis (1) .…”

Arthroscopic Surgery in Children and Adolescent – A Domain to Be Developed

“…Given the fibrous attachment on the fragment we found during surgery a fracture secondary to fibrous calcaneonavicular coalition is highly probable. Few open or miniopen techniques are described to remove the calcaneonavicular coalition [10]. Arthroscopy is an attractive method given the minimisation of the articular instability of the midfoot joint secondary to surgical approach.…”

Biomodelos tridimensionales para el tratamiento quirúrgico de coaliciones astrágalo-calcáneas

“…7 La afectación de la faceta posterior fue estimada para decidir si la barra era resecable de acuerdo al protocolo utilizado en nuestro servicio. 1 En aquellos pacientes que presentaban una coalición que afectaba menos de 50% de la faceta posterior se indicó resección de la misma. Si el AAC era mayor a 16 grados se indicó realineación asociada.…”

“…Las coaliciones tarsales representan una anomalía congénita en la cual existe una fusión fibrosa, cartilaginosa u ósea entre dos o más huesos del tarso. 1 La incidencia estimada en la población es de 1 a 6%; las más frecuentes son las localizadas entre el calcáneo-escafoides tarsiano y astrágalo-calcáneo (aproximadamente 90% de los casos reportados). 2,3 Un alto porcentaje de los pacientes que presentan esta patología suelen requerir tratamiento quirúrgico para aliviar el dolor, mejorar la movilidad o corregir la deformidad asociada.…”