Is Peroneal Spastic Flatfoot Causing Chronic Ankle Pain?

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If a young athlete has a history of ankle sprains and has pain in the subtalar or midtarsal area of the foot, he or she may have peroneal spastic flatfoot.
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Author(s): 
By Mark A. Caselli, DPM

What About Surgical Solutions?
Surgical treatment varies depending on the type of coalition present. The current recommendation for a calcaneonavicular bar is surgical resection of the coalition and interposition of fat, muscle or another inert material. This procedure is best reserved for children under the age of 14, who demonstrate no arthritic changes. In cases in which resection fails and a coalition reforms, or when you see degenerative changes in the tarsus, triple arthrodesis is used as a salvage procedure.
The surgical management of talocalcaneal coalitions remains controversial. Some authors say the degenerative changes in the talocalcaneal coalition are often present at the time of the initial diagnosis. In addition, resecting these bars often requires you to surgically excise the medial facet of the talocalcaneal joint, which results in considerable stress to the anterior and posterior facets.
Some believe this procedure leads to further degenerative arthritis. For this reason, many authors promote triple arthrodesis as an initial treatment. However, this operation severely restricts athletic potential and should be reserved for salvage when other approaches have failed.

Dr. Caselli (pictured) is Vice-President of the greater New York Regional Chapter of the American College of Sports Medicine and is a Professor in the Department of Orthopedic Sciences at the New York College of Podiatric Medicine.




References:

1. Brage ME, Larken J. Ankle, hindfoot, and midfoot injuries. In Reider B (ed) Sports Medicine: The School Age Athlete. Philadelphia, WB Saunders Company, 1996. pp 403-438

2. Caselli MA, Sobel E, McHall KA. Pediatric manifestations of musculoskeletal disease in children. Clin Podiatr Med Surg 15(3), 1998.

3. Donahoe BK, Kuhnell KA, Strenk ML. Rehabilitation of congenital and developmental conditions in children. In Sammarco GJ (ed) Rehabilitation of the Foot and Ankle. St. Louis, Mosby, 1995. pp 173-187.

4. Glockenberg A, Weinreb A, Pevny J. Rheumatoid arthritis-induced peroneal spastic flatfoot. J Am Podiatr Med Assoc 1987, 77: 185-187.

5. Lowy LJ. Pediatric peroneal spastic flatfoot in the absence of coalition, a suggested protocol. J Am Podiatr Med Assoc 1998, 88: 181-191.

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