Accessory anterolateral talar facet impingement with tibialis spastic varus foot

Abstract

In recent years, some authors have reported accessory anterolateral talar facet impingement with flatfoot including peroneal spastic flatfoot. Conversely, to our knowledge, no case report has been published about accessory anterolateral talar facet impingement with tibialis spastic varus foot. We report the first case in a 22-year-old man with intellectual disability, bilateral cleft hands and type 1 diabetes mellitus. Since spraining his left ankle over a year earlier, he experienced left sinus tarsi pain while standing and walking. Physical examination revealed that his left foot was in the varus position with spasm of the anterior tibial muscle, tenderness in the sinus tarsi and lateral hindfoot pain upon attempted passive hindfoot eversion. He could not stand on his left toes. His pain decreased after lying down and receiving a massage on his anterolateral lower leg at night. Radiographs and computed tomography scans revealed the absence of tarsal coalition and the presence of accessory anterolateral talar facet in both feet. Magnetic resonance imaging demonstrated abutting bone marrow edema between the talus and calcaneus around the accessory anterolateral talar facet. We diagnosed the patient with accessory anterolateral talar facet impingement and tibialis spastic varus foot. After conservative treatment failed, resection of accessory anterolateral talar facet achieved good results with short-term follow-up.

The talar morphology of a hypochondroplasic dwarf: A case study from the Italian Late Antique period

“…Limited inversion and eversion at the subtalar joint may also correlate with the presence of the accessory antero‐lateral talar facet in T17, suggesting talocalcaneal abnormal bridging, that is, tarsal coalition (Vossen et al, 2020) or atypical structure of the subtalar joint. In addition, the accessory antero‐lateral talar facet may have altered foot mechanics, causing pain at the lateral side of the hindfoot and inflamed soft tissues such as talocalcaneal ligaments (Hattori et al, 2015; Kurashige, 2017; Niki et al, 2014).…”

“…This would be consistent with passive eversion during stance phase. While limited eversion of the hindfoot of T17 is suggested by the shape of the less concave posterior calcaneal facet, the high BV/TV and DA values along the lateral side suggest that this individual may have been experiencing passive hindfoot eversion, inducing an abnormal subtalar osseous contact in the lateral side of the sinus tarsi , which would also explain the etiology of an accessory antero‐lateral talar facet (Figure 3) (Alqahtani et al, 2020; Hattori et al, 2015; Kurashige, 2017). The valgus knee condition, which is present in T17 (Figure 2), may also be a contributing factor to suggested lateral loading of the foot, given the laxity of ankle collateral ligaments observed in such a condition (Pauli, 2019).…”