Operative versus nonoperative treatment in children with painful rigid flatfoot and talocalcaneal coalition

Abstract

Background: The management of painful rigid flatfoot (RFF) with talocalcaneal coalition (TCC) is controversial. We aimed to compare operative and nonoperative treatment in children with RFF and TCC. Methods: We retrospectively reviewed medical records and radiographs of children with RFF and TTC treated between 2005 and 2015. The nonoperative treatment consisted of manipulation under anesthesia, cast immobilization and shoe insert after cast removal. The operative treatment consisted of combined TCC resection, graft interposition and subtalar arthroereisis. Results: Thirty-four children (47 ft) in the nonoperative group and twenty-one children (34 ft) in the operative group were included. No differences were found between groups, concerning baseline characteristics. The mean age at treatment was 11.8 years (9-17): 11.6 (9-17) for the nonoperative group, 12.2 (10-15) for the operative group. The mean follow-up averaged 6.6 (3-12) years and was significantly longer in the nonoperative group (7.8 versus 4.7 years; p < 0.0005), since the operative procedure was increasingly practiced in the latest years. There were no complications in either groups, but 6 patients (7 ft) in the nonoperative group were unsatisfied and required surgery. At the latest follow-up, the AOFAS-AHS improved in both groups, although the operative group showed significantly better improvement. The operative group reported also significantly better FADI score, after adjustment for follow-up and baseline variables. Conclusion: The operative treatment showed better results compared to the nonoperative treatment. Symptomatic RFF with TCC in children can be effectively treated in one step with resection, graft interposition and subtalar arthroereisis. Further prospective randomized studies are needed to confirm our findings and to identify the best operative strategy in this condition.

A new classification of talocalcaneal coalitions based on computed tomography for operative planning

“…Traditional open techniques may prolong hospitalization for wound management and pain control [ 28 ]. An open technique [ 29 , 30 ] is often performed with an incision over the sustentaculum tali, and then, identifying the bridge edge through the talonavicular joint anteriorly and the residual talocalcaneal joint. Finally, the coalition is resected until the articular cartilage is visible.…”

Resection of Calcaneonavicular and Talocalcaneal Coalitions With Surgical Correction of the Hindfoot Valgus Deformity in One Step

“…Giannini et al 10 reported resection of TCC and use of a bioabsorbable screw for subtalar arthroereisis (as endorthesis in the subtalar joint) in 12 patients with excellent and good results in 8 (57.1%) and 3 (21.4%) patients respectively. A nonbioabsorbable screw introduced into the talus was used with the aim of obtaining a “calcaneo-stop” effect in association to the TCC resection as described by Di Gennaro et al 8 in 21 patients with statistically significant AOFAS score improvement postoperatively. Knörr et al 16 reported 4 calcaneo-stop procedures simultaneously performed among 15 patients with symptomatic TCC after arthroscopic resection and a hindfoot valgus >20 degrees, with statistically significant increase in AOFAS score to 90.9 postoperatively.…”

Treatment for plano-valgus foot in children with subtalar arthroereisis. A review

“…The authors showed that patients in the operated group had better outcomes and seven children in the non-operated group required surgery. Only the patients' return to sport and physical activity was more rapid in the group that underwent non-operative treatment [17].…”

“…When reviewing the relevant literature and analysing the appropriate study groups for this experiment, we noted that, in the majority of the studies conducted in the field, boys composed more than half of the study group [1,2,22,17,10,23,24,3,4,18,19,12,13,14,20,25,21,26,7,15,8,16,9]. All the subjects were children with flatfoot and heel valgus.…”

“…If the lowering of the foot arches is still present after this period of time, appropriate examinations should be performed to diagnose for postural defects of the child's foot. Moreover, if the child reports additional symptoms, such as mobility problems, decreased endurance during physical activity [1,10,11,3,4,12,13,14,7,15,16,9], pain in the foot area, tenderness of the tarsal sinus [1,2,17,10,11,3,4,18,19,12,13,5,14,20,21,6,7,15,8,16,9], or forefoot abduction [1,2,10,4], and the patient does not respond to non-operative treatments, such as physiotherapy and the wearing of orthopaedic insoles [1,11,3,4,18,19,12,14,20,21,…”