Review Question - QID 1026

For symptomatic coalition before degenerative changes have occurred, resection is the usual treatment; however, this is not indicated if the patient has failed previous coalition resection surgery, and has greater than 50% involvement of the posterior facet of the subtalar joint. Triple arthrodesis involves fusion of the subtalar, calcaneocuboid, and talonavicular joints and is the most effective procedure for fixed hindfoot and forefoot deformities. Subtalar fusion can be performed in select cases with no significant hindfoot deformity. This procedure is contraindicated in young children (10-12 years) because of the limitation it puts on foot growth. Wilde et al found fair or poor results in all ten feet with preoperative CT scans showing an area of relative coalition to be >50% and heel valgus > 16 degrees. Scranton reported consistently successful resections of talocalcaneal coalitions if the coalition was less than one-half of the surface area of the talocalcaneal joint and there was no degenerative arthritic changes in the talonavicular joint.