Hemiendoprosthetics of the middle facet of the subtalar joint in the complex treatment of tarsal coalition: a case report

   Relevance. Tarsal coalition is a condition characterized by fusion of the bones of the posterior part of the foot and is most often clinically manifested in adolescence. Fusion of the bones of the posterior part of the foot disrupts the formation of the normal skeleton of the foot and leads to rigid deformation, severe pain syndrome and a decrease in the level of activity of patients. The results of the available treatment tactics are ambiguous, which necessitates the search for new methods to solve this problem.

   Aim. The paper presents the medium-term results of hemiendoprosthetics of the middle articular facet of the calcaneus with an original model of an implant made of zirconium ceramics in a patient with a fibrous coalition between the talus and calcaneus in combination with concomitant surgical techniques.

   Materials and methods. To assess the objective condition in the pre- and postoperative periods, the patient underwent stress radiography, computed multispiral tomography (MSCT), magnetic resonance imaging (MRI), and dynamic pedobarography. To assess the patient's subjective condition before surgery and after 12 months, a questionnaire was performed using a visually analog scale (VAS), AOFAS Ankle Hindfoot (AOFAS AH).

   Results. According to the survey data, a decrease in the intensity of pain syndrome and an increase in patient activity are determined. Your score before treatment was 9 points, 12 months after the treatment was 1 point. The indicators of the AOFAS AH scale before and after the treatment were 21 and 90 points, respectively. The correct position of the hemiendoprosthesis is determined on control instrumental studies, no signs of instability of the implant were revealed.

   Conclusion. The short-term results allow us to conclude that hemiendoprosthetics in combination with subtalar arthroeresis and plasty of the tendon of the posterior tibial muscle are highly effective as a method of treating patients with tarsal tarsal-calcaneal coalition. This technique allows you to maintain movement in the elbow joint and reduce the severity of the pain syndrome. Further work is planned on the use of hemiendoprostheses of the middle articular facet in patients with talon-heel coalitions of the foot.

1. Soni J.F., Valenza W., Matsunaga C. Tarsal coalition // Current Opinion in Pediatrics. Lippincott Williams and Wilkins, 2020. Vol. 32, № 1. P. 93–99. doi: 10.1097/MOP.0000000000000858

2. Moharamzadeh D., De Pellegrin M. Surgical Treatment of Calcaneonavicular and Talocalcaneal Coalitions // Foot Ankle Clin. 2021. Vol. 26, № 4. P. 873–901. doi: 10.1016/j.fcl.2021.07.011

3. Klammer G., Espinosa N., Iselin L.D. Coalitions of the Tarsal Bones // Foot Ankle Clin. 2018. Vol. 23, № 3. P. 435–449. doi: 10.1016/j.fcl.2018.04.011

4. Polt M. et al. Outcomes of surgical management for tarsal coalitions : a systematic review // Arch Orthop Trauma Surg. 2023. Vol. 143, № 12. P. 6993–7008.

5. Bemenderfer T.B. et al. Long-term Outcomes of Coalition Resection in Adult Tarsal Coalition // Foot Ankle Orthop. SAGE Publications Inc, 2020. Vol. 5, № 4. P. 2473011420S00122. doi: 10.1007/s00402-023-04982-z

6. Catanzano A.A.J. et al. Decision-Making and Management of Tarsal Coalition in the Young Adult Patient : A Critical Analysis Review // JBJS Rev. 2023. Vol. 11, № 6. doi: 10.2106/JBJS.RVW.23.00021

7. Patent N 2794325 Russian Federation, MPK A61B 17/56 (2006.01) A61F 2/42 (2006.01). Sposob lecheniya taranno-pyatochnoj koalicii s ispol’zovaniem keramicheskogo gemiendoproteza srednej sustavnoj fasetki podtarannogo sustava [Method for treating talocalcaneal coalition using a ceramic hemiendoprosthesis of the middle articular facet of the subtalar joint]: N 2022110563: Declared 19. 04. 2022: Published 17. 04. 2023 / Protsko V.G., Skrebtsov V.V. Bulletin No 11. (In Russian).

8. Harris R.I., Beath T. Etiology of peroneal spastic flat foot // J Bone Joint Surg Br. 1948. Vol. 30B 4. P. 624–634.

9. Nalaboff K., Schweitzer M. MRI of tarsal coalition: Frequency, distribution, and innovative signs // Bull NYU Hosp Jt Dis. 2008. Vol. 66. P. 14–21.

10. Zhou B., Tang K., Hardy M. Talocalcaneal coalition combined with flatfoot in children: diagnosis and treatment : a review // J Orthop Surg Res. 2014. Vol. 9. P. 129. doi: 10.1186/s13018-014-0129-9

11. Jackson T.J. et al. Incidence of Symptomatic Pediatric Tarsal Coalition in Olmsted County: A Population-Based Study // JBJS. 2021. Vol. 103, № 2. doi: 10.2106/JBJS.20.00707

12. Murphy J.S., Mubarak S.J. Talocalcaneal Coalitions // Foot Ankle Clin. 2015. Vol. 20, № 4. P. 681–691. doi: 10.1016/j.fcl.2015.07.009

13. Damiano J. Diagnostic d’une douleur du pied chez l’adulte // Revue du Rhumatisme Monographies. 2014. Vol. 81.

14. Graham Jr. J.M. et al. Syndrome of coronal craniosynostosis with brachydactyly and carpal/tarsal coalition due to Pro250Arg mutation in FGFR3 gene // Am J Med Genet. John Wiley & Sons, Ltd, 1998. Vol. 77, № 4. P. 322–329. doi: 10.1002/(sici)1096-8628(19980526)77:4<322::aidajmg14>3.0.co;2-k

15. Staser J., Karmazyn B., Lubicky J. Radiographic diagnosis of posterior facet talocalcaneal coalition // Pediatr Radiol. 2007. Vol. 37, № 1. P. 79–81. doi: 10.1007/s00247-006-0335-7

16. Bartoníček J., Rammelt S., Naňka O. Anatomy of the Subtalar Joint // Foot Ankle Clin. 2018. Vol. 23, № 3. P. 315–340. doi: 10.1016/j.fcl.2018.04.001

17. Lyon R., Liu X., Cho S.-J. Effects of Tarsal Coalition Resection on Dynamic Plantar Pressures and Electromyography of Lower Extremity Muscles // J Foot Ankle Surg. 2005. Vol. 44. P. 252–258. doi: 10.1053/j.jfas.2005.04.003

18. Hetsroni I. et al. Walking and Running Plantar Pressure Analysis before and after Resection of Tarsal Coalition // Foot Ankle Int. SAGE Publications Inc, 2007. Vol. 28, № 5. P. 575–580. doi: 10.3113/FAI.2007.0575

19. Hayashi K., Kumai T., Tanaka Y. Endoscopic resection of a talocalcaneal coalition using a posteromedial approach // Arthrosc Tech. Elsevier, 2014. Vol. 3, № 1. doi: 10.1016/j.eats.2013.08.005

20. Thorpe S.W., Wukich D.K. Tarsal Coalitions in the Adult Population: Does Treatment Differ from the Adolescent? // Foot Ankle Clin. 2012. Vol. 17, № 2. P. 195–204. doi: 10.1016/j.fcl.2012.03.004

21. Dermanis A.A. et al. Talocalcaneal Coalition Resection in the Adult Population : A Systematic Review // Cureus. Cureus, Inc., 2022. Vol. 14, № 10. P. e30581. doi: 10.7759/cureus.30581

22. Saxena A., Erickson S. Tarsal coalitions: Activity levels with and without surgery // J Am Podiatr Med Assoc. 2003. Vol. 93. P. 259–263. doi: 10.7547/87507315-93-4-259

23. Gonzalez P., Kumar S.J. Calcaneonavicular coalition treated by resection and interposition of the extensor digitorum brevis muscle // JBJS. 1990. Vol. 72, № 1.

24. Saltzman C.L. et al. Triple Arthrodesis: Twenty-five and Forty-four-Year Average Follow-up of the Same Patients* // JBJS. 1999. Vol. 81, № 10.

25. Olney B.W., Asher M.A. Excision of symptomatic coalition of the middle facet of the talocalcaneal joint. // JBJS. 1987. Vol. 69, № 4.

26. Banerjee S. et al. Arthroscopic Subtalar Arthrodesis as a Treatment Strategy for Subtalar Arthritis : A Systematic Review // The Journal of Foot and Ankle Surgery. Elsevier, 2021. Vol. 60, № 5. P. 1023–1028. doi: 10.1053/j.jfas.2021.04.006

27. Kothari A., Masquijo J. Surgical treatment of tarsal coalitions in children and adolescents // EFORT Open Rev. British Editorial Society of Bone and Joint Surgery, 2020. Vol. 5, № 2. P. 80–89. doi: 10.1302/2058-5241.5.180106

28. Bemenderfer T. et al. Long-term Outcomes of Coalition Resection in Adult Tarsal Coalition // Foot Ankle Orthop. 2020. Vol. 5. P. 2473011420S0012.

29. Park J.J. et al. Racial differences in prevalence and anatomical distribution of tarsal coalition // Sci Rep. 2022. Vol. 12, № 1. P. 21567. doi: 10.1038/s41598-022-26049-6

30. Bernasconi A., Lintz F., Sadile F. The role of arthroereisis of the subtalar joint for flatfoot in children and adults // EFORT Open Rev. 2017. Vol. 2. P. 438–446. doi: 10.1302/2058-5241.2.170009

31. Abbara-Czardybon M. et al. Möglichkeiten und Grenzen der subtalaren Arthrorise im Kindesalter // Orthopade. 2013. Vol. 42, № 1. P. 12–19.

32. Scranton P.E.J. Treatment of symptomatic talocalcaneal coalition // JBJS. 1987. Vol. 69, № 4.

33. Yildiz K.I. et al. Functional and Radiological Outcomes After Tarsal Coalition Resections: A Minimum 5-Year Follow-Up // The Journal of Foot and Ankle Surgery. Elsevier, 2019. Vol. 58, № 6. P. 1223–1228. doi: 10.1053/j.jfas.2018.12.040

34. Giannini S. et al. Operative Treatment of Flatfoot With Talocalcaneal Coalition // Clin Orthop Relat Res. 2003. Vol. 411. doi: 10.1097/01.blo.0000069897.31220.7a

35. Khoshbin A. et al. Reoperations After Tarsal Coalition Resection: A Population-Based Study // The Journal of Foot and Ankle Surgery. Elsevier, 2015. Vol. 54, № 3. P. 306–310. doi: 10.1053/j.jfas.2014.04.027

36. King A., Parsons S. Endoscopic Resection of Tarsal Coalitions // Foot and Ankle Clinics. W.B. Saunders, 2020. Vol. 25, № 3. P. 493–503. doi: 10.1016/j.fcl.2020.05.009

37. Mo Ts., Rigin N.V., Bobrov D.S., Slinyakov L.Yu. ankety i shkaly dlya otsenki sostoyaniya stopy i golenostopnogo sustava. Kafedra travmatologii i ortopedii. 2016;4 (20):5-11

38. Bobrov D.S., Artemov K.D. endoprotezirovanie golenostopnogo sustava: osobennosti i iskhody vmeshatel’stva (obzor literatury). Kafedra travmatologii i ortopedii. 2021;2 (44):30-40.