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Pediatric Tarsal Coalition and Pes Planovalgus

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The Pediatric Foot and Ankle

Abstract

Tarsal coalitions are a frequent cause of “ankle pain” in pediatric patients. There is a wide variety of presentations, from incidental finding with no symptoms in a rectus foot to painful peroneal spastic flatfoot with significant arthritic findings. Plain radiographs commonly show a tarsal halo sign in a STJ middle facet coalition. Talar beaking is commonly seen on the lateral radiograph. Calcaneonavicular bar coalition shows a continuous bridge or square fibrous bridge of the dorsal-lateral calcaneus. Other coalitions in most any of the tarsal joints or adjacent bones can occur, but with much less frequency. Thin-slice CT imaging is recommended for further evaluation. Surgery is helpful to separate a CN bar, but other joints involving arthritis will benefit from fusion procedures. Ancillary measures should be considered to correct for equinus contracture (gastrocnemius recession), pes planovalgus (Evans osteotomy, Cotton osteotomy), and multilevel fusion when necessary. Distraction arthrodesis with allograft is helpful in correcting pes planovalgus in a middle facet coalition. In situ fusion with allograft bone grafting can be performed when there is a complete medial bone bridge of the middle facet and no valgus heel position. Individualized surgical planning is based on location of coalition, presence of deformity, and adjacent joint arthritis or malalignment.

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Author information

Authors and Affiliations

  1. Pediatric and Adult Reconstructive Foot & Ankle Surgery Fellowship, Atlanta, GA, USA

    Craig A. Camasta

  2. Department of Surgery, Emory St. Joseph’s Hospital, Atlanta, GA, USA

    Craig A. Camasta

  3. Faculty, The Podiatry Institute, Decatur, GA, USA

    Craig A. Camasta

  4. Private Practice, Motio Foot and Ankle Specialists, Winter Springs, FL, USA

    Timothy A. Graeser

Authors
  1. Craig A. Camasta
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Editors and Affiliations

  1. Williamsburg Regional Hospital, Kingstree, SC, USA

    Michelle L. Butterworth

  2. Steward - St. Elizabeth’s Medical Center, Brighton, MA, USA

    John T. Marcoux

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Camasta, C.A., Graeser, T.A. (2020). Pediatric Tarsal Coalition and Pes Planovalgus. In: Butterworth, M., Marcoux, J. (eds) The Pediatric Foot and Ankle. Springer, Cham. https://doi.org/10.1007/978-3-030-29788-6_11

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  • DOI: https://doi.org/10.1007/978-3-030-29788-6_11

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