Abstract
Between 1978 and 1999, surgical treatment for talocalcaneal coalitions which failed to respond to any conservative treatment was performed. Materials consisted of 46 patients (50 feet), including 26 males (29 feet) and 20 females (21 feet). The patients’ age at the time of operation ranged from 8 to 66 years (average, 22.5 years). Major symptoms included local pain (43 feet), tumor (19 feet), numbness of the plantar side (17 feet), peroneal muscle spasm (13 feet), and varus instability of the ankle (3 feet). Major signs included limited motion of the subtalar joint (50 feet), palpation of tumor (34 feet), sensory disturbance of the plantar side (14 feet), peroneal spastic flat foot (3 feet), and limited dorsiflexion of the ankle due to contracture of the gastrocnemius muscle (2 feet). The regions of the coalitions included middle type (36 feet), posterior type (9 feet), and diffuse type (3 feet). The coalitions were all incomplete unions, that is to say fibrous or cartilaginous unions.
Surgical treatments were as follows: coalitions were excised and subtalar joints were mobilized in 31, resections alone were carried out on 16, and 3 feet underwent arthrodesis of the subtalar joint. Results of surgical treatments were evaluated using our own clinical scoring system. 28 feet were excellent, 13 were good, 8 were fair, and one foot was poor.
In principle, the purpose of surgical treatment of these coalitions involved excising the tumor to release the plantar nerve from compression and resection the coalition to gain physiological subtalar motion. However, patients experiencing osteoarthrotic changes and whose coalitions occupy most of the subtalar joint should undergo an arthrodesis of the subtalar joint.
The abstracts were prepared by Mr Simon Donell. Correspondence should be addressed to him at the Department of Orthopaedics, Norfolk & Norwich Hospital, Level 4, Centre Block, Colney Lane, Norwich NR4 7UY, United Kingdom.
