A computed tomography assessment of hindfoot alignment in patients with tarsal coalitions
Article Sidebar
Published:
Apr 14, 2021
Keywords:
Tarsal coalition, computed tomography, alignment, foot, children
Main Article Content
Abstract
Background: The aim of this study is to analyze the hindfoot alignment with computed tomography (CT-scan) in patients with tarsal coalitions.
Materials and Methods: Eighty-five patients (78 feet) between 9 and 17 years of age were included and divided into 3 groups: A) without coalitions (control group, N 29 ), B) with calcaneal-navicular coalitions (CNC group, N 31), and C) with talo-calcaneal coalitions (TCC group, N 25). Five measurements were assessed: Inftal-Suptal, Inftal-Hor, Inftal-Supcal, Suptal-Infcal, and Talo-calcaneal angle (TCA).
Results: Demographic data revealed no differences between groups with respect to patient’s age and sex (p = 0.3630 and 0.2415 respectively). Patients with tarsal coalitions presented significantly higher values in all measurements compared to the control group (p = <0.05 Kruskall-Wallis / ANOVA). TCA measurements in the patients with CNC and TCC were significantly superior to the control group (10.09 ± 4.60, 17.77 ± 11.28 and 28.66 ± 8.89 respectively, p = <0.0001). TCA distribution in the patients with CNC presented great variability, while group 3 (TCC) presented mostly a valgus alignment pattern. We did not find a direct correlation between the TCA and Inftal-Hor values (Spearman 0.27013, p = 0.1916).
Conclusion: Patients with tarsal coalitions show an increased valgus orientation of the hindfoot. The deformity is greater in patients with TCC, while in those with CNC demonstrated a great variability. The increase in the hindfoot valgus does not necessarily indicate an increase in the inclination of the subtalar joint, so the latter must be evaluated separately at the time of preoperative planning.
Level of Evidence: III
Materials and Methods: Eighty-five patients (78 feet) between 9 and 17 years of age were included and divided into 3 groups: A) without coalitions (control group, N 29 ), B) with calcaneal-navicular coalitions (CNC group, N 31), and C) with talo-calcaneal coalitions (TCC group, N 25). Five measurements were assessed: Inftal-Suptal, Inftal-Hor, Inftal-Supcal, Suptal-Infcal, and Talo-calcaneal angle (TCA).
Results: Demographic data revealed no differences between groups with respect to patient’s age and sex (p = 0.3630 and 0.2415 respectively). Patients with tarsal coalitions presented significantly higher values in all measurements compared to the control group (p = <0.05 Kruskall-Wallis / ANOVA). TCA measurements in the patients with CNC and TCC were significantly superior to the control group (10.09 ± 4.60, 17.77 ± 11.28 and 28.66 ± 8.89 respectively, p = <0.0001). TCA distribution in the patients with CNC presented great variability, while group 3 (TCC) presented mostly a valgus alignment pattern. We did not find a direct correlation between the TCA and Inftal-Hor values (Spearman 0.27013, p = 0.1916).
Conclusion: Patients with tarsal coalitions show an increased valgus orientation of the hindfoot. The deformity is greater in patients with TCC, while in those with CNC demonstrated a great variability. The increase in the hindfoot valgus does not necessarily indicate an increase in the inclination of the subtalar joint, so the latter must be evaluated separately at the time of preoperative planning.
Level of Evidence: III
Downloads
Download data is not yet available.
Metrics
Metrics Loading ...
Article Details
How to Cite
Masquijo, J. J., Carabajal Matar, M., Allende, F., Torres Gomez, A., & Tourn, D. (2021). A computed tomography assessment of hindfoot alignment in patients with tarsal coalitions. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 86(2), 151-158. https://doi.org/10.15417/issn.1852-7434.2021.86.2.1166
Issue
Section
Clinical Research
Copyright (c) 2021 Revista de la Asociación Argentina de Ortopedia y Traumatología
Manuscript acceptance by the Journal implies the simultaneous non-submission to any other journal or publishing house. The RAAOT is under the Licencia Creative Commnos Atribución-NoComercial-Compartir Obras Derivadas Igual 4.0 Internacional (CC-BY-NC.SA 4.0) (http://creativecommons.org/licences/by-nc-sa/4.0/deed.es). Articles can be shared, copied, distributed, modified, altered, transformed into a derivative work, executed and publicly communicated, provided a) the authors and the original publication (Journal, Publisher and URL) are mentioned, b) they are not used for commercial purposes, c) the same terms of the license are maintained.
In the event that the manuscript is approved for its next publication, the authors retain the copyright and will assign to the journal the rights of publication, edition, reproduction, distribution, exhibition and communication at a national and international level in the different databases. data, repositories and portals.
It is hereby stated that the mentioned manuscript has not been published and that it is not being printed in any other national or foreign journal.
The authors hereby accept the necessary modifications, suggested by the reviewers, in order to adapt the manuscript to the style and publication rules of this Journal.
References
1. Kernbach KJ. Tarsal coalitions: etiology, diagnosis, imaging, and stigmata. Clin Podiatr Med Surg 2010;27(1):105-17. https://doi.org/10.1016/j.cpm.2009.08.006
2. Cooperman DR, Janke BE, Gilmore A, Latimer BM, Brinker MR, Thompson GH. A three-dimensional study of
calcaneonavicular tarsal coalitions. J Pediatr Orthop 2001;21(5):648-51. PMID: 11521035
3. Stormont DM, Peterson HA. The relative incidence of tarsal coalition. Clin Orthop 1983;(181):28-36.
PMID: 6641062
4. Masquijo JJ, Jarvis J. Associated talocalcaneal and calcaneonavicular coalitions in the same foot. J Pediatr Orthop B 2010;19(6):507-10. https://doi.org/10.1097/BPB.0b013e32833ce484
5. Mubarak SJ, Patel PN, Upasani VV, Moor MA, Wenger DR. Calcaneonavicular coalition: treatment by excision and fat graft. J Pediatr Orthop 2009;29(5):418-26. https://doi.org/10.1097/BPO.0b013e3181aa24c0
6. Kothari A, Masquijo J. Surgical treatment of tarsal coalitions in children and adolescents. EFORT Open Rev
2020;5(2):80-9. http://doi.org/10.1302/2058-5241.5.180106
7. Masquijo JJ, Vazquez I, Allende V, Lanfranchi L, Torres-Gomez A, Dobbs MB. Surgical reconstruction for
talocalcaneal coalitions with severe hindfoot valgus deformity. J Pediatr Orthop 2017;37(4):293-7. https://doi.org/10.1097/BPO.0000000000000642
8. Probasco W, Haleem AM, Yu J, Sangeorzan BJ, Deland JT, Ellis SJ. Assessment of coronal plane subtalar joint
alignment in peritalar subluxation via weight-bearing multiplanar imaging. Foot Ankle Int 2015;36(3):302-9.
https://doi.org/10.1177/1071100714557861
9. Masquijo JJ, Torres-Gomez A, Tourn D. Fiabilidad del ángulo astrágalo-calcáneo. Rev Esp Cir Ortop Traumatol
2019;63(1):20-3. https://doi.org/10.1016/j.recot.2018.08.003
10. Wilde PH, Torode IP, Dickens DR, Gole WG. Resection for symptomatic talocalcaneal coalition. J Bone Joint Surg Br 1994;76(5):797-801. PMID: 8083272
11. Upasani VV, Chambers RC, Mubarak SJ. Analysis of calcaneonavicular coalitions using multi-planar threedimensional computed tomography. J Child Orthop 2008;2:301-7. https://doi.org/10.1007/s11832-008-0111-3
12. Rozansky A, Varley E, Moor M, Wenger DR, Mubarak SJ. A radiologic classification of talocalcaneal coalitions
based on 3D reconstruction. J Child Orthop 2010;4(2):129-35. https://doi.org/10.1007/s11832-009-0224-3
13. Kemppainen J, Pennock AT, Roocroft JH, Bastrom TP, Mubarak SJ. The use of a portable CT scanner for the
intraoperative assessment of talocalcaneal coalition resections. J Pediatr Orthop 2014;34(5):559-64.
https://doi.org/10.1097/BPO.0000000000000176
14. Aibinder WR, Young EY, Milbrandt TA. Intraoperative three-dimensional navigation for talocalcaneal coalition
resection. J Foot Ankle Surg 2017;56(5):1091-4. https://doi.org/10.1053/j.jfas.2017.05.046
15. Stokman JJ, Mitchell J, Noonan K. Subtalar coalition resection utilizing live navigation: a technique tip. J Child
Orthop 2018;12(1):42-6. https://doi.org/10.1302/1863-2548.12.170131
16. de Wouters S, Tran Duy K, Docquier PL. Patient-specific instruments for surgical resection of painful tarsal
coalition in adolescents. Orthop Traumatol Surg Res 2014;100(4):423-7. https://doi.org/10.1016/j.otsr.2014.02.009
17. Sobrón FB, Benjumea A, Alonso MB, Parra G, Pérez-Mañanes R, Vaquero J. 3D printing surgical guide for
talocalcaneal coalition resection: technique tip. Foot Ankle Int 2019;40(6):727-32. https://doi.org/10.1177/1071100719833665
18. Mosca VS, Bevan WP. Talocalcaneal tarsal coalitions and the calcaneal lengthening osteotomy: the role of deformity correction. J Bone Joint Surg Am 2012;94(17):1584-94. https://doi.org/10.2106/JBJS.K.00926
19. El Shazly O, Mokhtar M, Abdelatif N, Hegazy M, El Hilaly R, El Zohairy A, et al. Coalition resection and medial
displacement calcaneal osteotomy for treatment of symptomatic talocalcaneal coalition: functional and clinical
outcome. Int Orthop 2014;38(12):2513-7. https://doi.org/10.1007/s00264-014-2535
20. Gantsoudes GD, Roocroft JH, Mubarak SJ. Treatment of talocalcaneal coalitions. J Pediatr Orthop 2012;32(3):301-7. https://doi.org/10.1097/BPO.0b013e318247c76e
21. Hamel J. Resection of talocalcaneal coalition in children and adolescents without and with osteotomy of the
calcaneus. Oper Orthop Traumatol 2009;21(2):180-92. https://doi.org/10.1007/s00064-009-1706-7
22. Lisella JM, Bellapianta JM, Manoli A 2nd. Tarsal coalition resection with pes planovalgus hindfoot reconstruction. J Surg Orthop Adv 2011;20(2):102-5. PMID: 21838070
23. Mahan ST, Spencer SA, Vezeridis PS, Kasser JR. Patient-reported outcomes of tarsal coalitions treated with surgical excision. J Pediatr Orthop 2015;35(6):583-8. https://doi.org/10.1097/BPO.0000000000000334
24. Quinn EA, Peterson KS, Hyer CF. Calcaneonavicular coalition resection with pes planovalgus reconstruction. J Foot Ankle Surg 2016;55(3):578-82. https://doi.org/10.1053/j.jfas.2016.01.048
25. Lintz F, de Cesar Netto C, Barg A, Burssens A, Richter M; Weight Bearing CT International Study Group. Weightbearing cone beam CT scans in the foot and ankle. EFORT Open Rev 2018;3(5):278-86.
https://doi.org/10.1302/2058-5241.3.170066
26. de Cesar Netto C, Schon LC, Thawait GK, Furtado da Fonseca L, Chinanuvathana A, Zbijewski WB, et al. Flexible adult acquired flatfoot deformity: comparison between weight-bearing and non-weight-bearing measurements using cone-beam computed tomography. J Bone Joint Surg Am 2017;99(18):e98. https://doi.org/10.2106/JBJS.16.01366
2. Cooperman DR, Janke BE, Gilmore A, Latimer BM, Brinker MR, Thompson GH. A three-dimensional study of
calcaneonavicular tarsal coalitions. J Pediatr Orthop 2001;21(5):648-51. PMID: 11521035
3. Stormont DM, Peterson HA. The relative incidence of tarsal coalition. Clin Orthop 1983;(181):28-36.
PMID: 6641062
4. Masquijo JJ, Jarvis J. Associated talocalcaneal and calcaneonavicular coalitions in the same foot. J Pediatr Orthop B 2010;19(6):507-10. https://doi.org/10.1097/BPB.0b013e32833ce484
5. Mubarak SJ, Patel PN, Upasani VV, Moor MA, Wenger DR. Calcaneonavicular coalition: treatment by excision and fat graft. J Pediatr Orthop 2009;29(5):418-26. https://doi.org/10.1097/BPO.0b013e3181aa24c0
6. Kothari A, Masquijo J. Surgical treatment of tarsal coalitions in children and adolescents. EFORT Open Rev
2020;5(2):80-9. http://doi.org/10.1302/2058-5241.5.180106
7. Masquijo JJ, Vazquez I, Allende V, Lanfranchi L, Torres-Gomez A, Dobbs MB. Surgical reconstruction for
talocalcaneal coalitions with severe hindfoot valgus deformity. J Pediatr Orthop 2017;37(4):293-7. https://doi.org/10.1097/BPO.0000000000000642
8. Probasco W, Haleem AM, Yu J, Sangeorzan BJ, Deland JT, Ellis SJ. Assessment of coronal plane subtalar joint
alignment in peritalar subluxation via weight-bearing multiplanar imaging. Foot Ankle Int 2015;36(3):302-9.
https://doi.org/10.1177/1071100714557861
9. Masquijo JJ, Torres-Gomez A, Tourn D. Fiabilidad del ángulo astrágalo-calcáneo. Rev Esp Cir Ortop Traumatol
2019;63(1):20-3. https://doi.org/10.1016/j.recot.2018.08.003
10. Wilde PH, Torode IP, Dickens DR, Gole WG. Resection for symptomatic talocalcaneal coalition. J Bone Joint Surg Br 1994;76(5):797-801. PMID: 8083272
11. Upasani VV, Chambers RC, Mubarak SJ. Analysis of calcaneonavicular coalitions using multi-planar threedimensional computed tomography. J Child Orthop 2008;2:301-7. https://doi.org/10.1007/s11832-008-0111-3
12. Rozansky A, Varley E, Moor M, Wenger DR, Mubarak SJ. A radiologic classification of talocalcaneal coalitions
based on 3D reconstruction. J Child Orthop 2010;4(2):129-35. https://doi.org/10.1007/s11832-009-0224-3
13. Kemppainen J, Pennock AT, Roocroft JH, Bastrom TP, Mubarak SJ. The use of a portable CT scanner for the
intraoperative assessment of talocalcaneal coalition resections. J Pediatr Orthop 2014;34(5):559-64.
https://doi.org/10.1097/BPO.0000000000000176
14. Aibinder WR, Young EY, Milbrandt TA. Intraoperative three-dimensional navigation for talocalcaneal coalition
resection. J Foot Ankle Surg 2017;56(5):1091-4. https://doi.org/10.1053/j.jfas.2017.05.046
15. Stokman JJ, Mitchell J, Noonan K. Subtalar coalition resection utilizing live navigation: a technique tip. J Child
Orthop 2018;12(1):42-6. https://doi.org/10.1302/1863-2548.12.170131
16. de Wouters S, Tran Duy K, Docquier PL. Patient-specific instruments for surgical resection of painful tarsal
coalition in adolescents. Orthop Traumatol Surg Res 2014;100(4):423-7. https://doi.org/10.1016/j.otsr.2014.02.009
17. Sobrón FB, Benjumea A, Alonso MB, Parra G, Pérez-Mañanes R, Vaquero J. 3D printing surgical guide for
talocalcaneal coalition resection: technique tip. Foot Ankle Int 2019;40(6):727-32. https://doi.org/10.1177/1071100719833665
18. Mosca VS, Bevan WP. Talocalcaneal tarsal coalitions and the calcaneal lengthening osteotomy: the role of deformity correction. J Bone Joint Surg Am 2012;94(17):1584-94. https://doi.org/10.2106/JBJS.K.00926
19. El Shazly O, Mokhtar M, Abdelatif N, Hegazy M, El Hilaly R, El Zohairy A, et al. Coalition resection and medial
displacement calcaneal osteotomy for treatment of symptomatic talocalcaneal coalition: functional and clinical
outcome. Int Orthop 2014;38(12):2513-7. https://doi.org/10.1007/s00264-014-2535
20. Gantsoudes GD, Roocroft JH, Mubarak SJ. Treatment of talocalcaneal coalitions. J Pediatr Orthop 2012;32(3):301-7. https://doi.org/10.1097/BPO.0b013e318247c76e
21. Hamel J. Resection of talocalcaneal coalition in children and adolescents without and with osteotomy of the
calcaneus. Oper Orthop Traumatol 2009;21(2):180-92. https://doi.org/10.1007/s00064-009-1706-7
22. Lisella JM, Bellapianta JM, Manoli A 2nd. Tarsal coalition resection with pes planovalgus hindfoot reconstruction. J Surg Orthop Adv 2011;20(2):102-5. PMID: 21838070
23. Mahan ST, Spencer SA, Vezeridis PS, Kasser JR. Patient-reported outcomes of tarsal coalitions treated with surgical excision. J Pediatr Orthop 2015;35(6):583-8. https://doi.org/10.1097/BPO.0000000000000334
24. Quinn EA, Peterson KS, Hyer CF. Calcaneonavicular coalition resection with pes planovalgus reconstruction. J Foot Ankle Surg 2016;55(3):578-82. https://doi.org/10.1053/j.jfas.2016.01.048
25. Lintz F, de Cesar Netto C, Barg A, Burssens A, Richter M; Weight Bearing CT International Study Group. Weightbearing cone beam CT scans in the foot and ankle. EFORT Open Rev 2018;3(5):278-86.
https://doi.org/10.1302/2058-5241.3.170066
26. de Cesar Netto C, Schon LC, Thawait GK, Furtado da Fonseca L, Chinanuvathana A, Zbijewski WB, et al. Flexible adult acquired flatfoot deformity: comparison between weight-bearing and non-weight-bearing measurements using cone-beam computed tomography. J Bone Joint Surg Am 2017;99(18):e98. https://doi.org/10.2106/JBJS.16.01366