Special Kaiser section| Volume 47, ISSUE 3, P180-190, May 2008

Bilateral Single-stage Middle Facet Talocalcaneal Coalition Resection Combined with Flatfoot Reconstruction: A Report of 3 Cases and Review of the Literature. Investigations Involving Middle Facet Coalitions—Part 1

  • Klaus J. Kernbach
    Resident Podiatric Surgeon, Department of Podiatry, Kaiser Foundation Hospital, Vallejo, CA.
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  • Neal M. Blitz
    Address correspondence to: Neal M. Blitz, DPM, FACFAS, Attending Podiatric Surgeon, Research Director, Kaiser North Bay Consortium Residency Program, Department of Orthopedics and Foot & Ankle Surgery, Kaiser Permanente Medical Centers, 3925 Old Redwood Highway, Santa Rosa, CA 95403.
    Attending Podiatric Surgeon, Research Director, Kaiser North Bay Consortium Residency Program, Department of Orthopedics and Foot & Ankle Surgery, Kaiser Permanente Medical Centers, Santa Rosa, CA.
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  • Shannon M. Rush
    Attending Podiatric Surgeon, San Francisco Bay Area Foot and Ankle Residency, Department of Orthopedics and Podiatric Surgery, Kaiser Permanente Medical Centers, Walnut Creek, CA.
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      Talocalcaneal middle facet coalitions are associated with rigid pes planovalgus that often requires surgical intervention. Simple resection of the coalition is preferred for symptomatic cases in the absence of rearfoot arthritis. While resection of the coalition will remove the osseous restriction of motion and may eliminate pain, the procedure does not specifically correct the concomitant pes planovalgus. In this report of 6 feet in 3 patients, we advocate combining resection of the coalition with concomitant flatfoot reconstruction in a single-stage operation. The patients in this series averaged 13.67 (range 12–17) years of age at the time of their foot surgeries, and their follow-up averaged 30 (range 16–54) months. All of the patients displayed bilateral middle facet talocalcaneal coalitions and underwent bilateral resection combined with flatfoot reconstruction. Each patient had 1 foot corrected followed by a period of at least 6 months before the contralateral foot was corrected. The mean postoperative American Orthopaedic Foot and Ankle Society ankle-hindfoot score was excellent (94.33 ± 2.81 points) overall. The median radiographic values for calcaneal inclination, Meary's, and anteroposterior talar-first metatarsal angles demonstrated statistically significant improvements: 9° (3°, 13°) (P = .0273), 4° (2°, 7°) (P = .0269), and 6° (3°, 11°) (P = .0277), respectively, and all feet demonstrated improved subtalar joint motion without pain. Although long-term results remain to be determined in a larger cohort, it is hoped that this combined approach to talocalcaneal coalition will delay or obviate future rearfoot arthrosis and the need for arthrodesis. Level of Clinical Evidence: 4.

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