Keys To Treating Tarsal Coalitions

Start Page: 48

An Overview Of The Articular Classification System*

Juvenile (osseous immaturity)
Type I: Extra-articular coalition
A: No secondary arthritis
B: Secondary arthritis
Type II: Intra-articular coalition
A: No secondary arthritis
B: Secondary arthritis

Adult (osseous maturity)
Type I: Extra-articular coalition
A: No secondary arthritis
B: Secondary arthritis
Type II: Intra-articular coalition
A: No secondary arthritis
B: Secondary arthritis

* This classification of tarsal coalitions is based on age, articular involvement and secondary arthritic changes. The classification may be used as a foundation for the discussion of surgical management.

56
Author(s): 
Michael S. Downey, DPM, FACFAS

   In contrast, with a calcaneonavicular coalition resection, there is a noted reduction in pain with generally greater functional improvement and motion. A full return of joint motion following coalition resection does not appear to be necessary for a successful result.1,18

In Summary

Tarsal coalitions remain a challenging pedal condition to manage successfully. Knowledge of the signs and symptoms of tarsal coalition along with a vigilant index of suspicion for the potential presence of a tarsal coalition are necessary to identify and diagnose the entity. Conservative treatment for a tarsal coalition is generally oriented toward rest, immobilization, offloading, biomechanical control and anti-inflammatory modalities.

   When conservative treatment fails or is superfluous, surgery is often indicated. The criteria for successful surgical intervention and deciding between resection approaches and arthrodesis are slowly becoming better elucidated. Currently, the evidence suggests that the most important parameters to consider when developing a surgical treatment plan are patient age, articular involvement, the presence or absence of secondary arthritic and adaptive changes, the size of the coalition and the severity of any hindfoot valgus.

   Dr. Downey is the Chief of the Division of Podiatric Surgery at Penn Presbyterian Medical Center in Philadelphia. He is also a Senior Faculty Member of the Podiatry Institute. Dr. Downey is also a Fellow of the American College of Foot and Ankle Surgeons.

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