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Tarsal Coalition and Pes Planovalgus: Clinical Examination, Diagnostic Imaging, and Surgical Planning

  • Craig A. Camasta
  • Timothy A. Graeser
Chapter

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.

Keywords

Tarsal coalition Pediatric ankle pain Peroneal spasm Coalition surgery Equinus Pes valgus Obese juvenile arthritic flatfoot Subtalar joint distraction arthrodesis In situ subtalar joint arthrodesis Asymptomatic coalition 

Supplementary material

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Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Craig A. Camasta
    • 1
    • 2
    • 3
  • Timothy A. Graeser
    • 4
  1. 1.Pediatric and Adult Reconstructive Foot & Ankle Surgery FellowshipAtlantaUSA
  2. 2.Department of SurgeryEmory St. Joseph’s HospitalAtlantaUSA
  3. 3.Faculty, The Podiatry InstituteDecaturUSA
  4. 4.Private Practice, Motio Foot and Ankle SpecialistsWinter SpringsUSA

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