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Rigid Flatfoot
Aka: Rigid Flatfoot, Tarsal Coalition, Calcaneonavicular coalition, Talocalcaneal coalition, Subtalar coalition
- Epidemiology
- Prevalence: <1% of U.S. population
- Gradual onset in adolescence
- Etiology
- Tarsal Coalition
- Congenital cartilaginous, fibrous or bony bridges
- Bridges form between Calcaneus, talus, and navicular
- Hindfoot Arthritis
- Pathophysiology
- Tarsal Coalition results in range of motion loss
- Local irritation
- Protective spasm of the peroneal Muscles
- Types
- Fusion or bridge type
- Fibrous fusion (Syndesmosis)
- Cartilaginous fusion (Synchondrosis)
- Osseous fusion (Synostosis)
- Distribution of fusion
- Calcaneonavicular coalition (53% of cases)
- Talocalcaneal coalition or Subtalar coalition (37%)
- Symptoms
- Bilateral involvement in 50% of cases
- Foot stiffness
- Painful limp
- Signs
- Tenderness over peroneal tendons or hindfoot
- Heel everted
- Subtalar joint (midtarsal) range of motion
- Limited and painful
- Provocative maneuvers
- Passive Stretching of peroneal tendons
- Forefoot Adduction and Inversion
- Swelling suggests other comorbid condition
- Rheumatoid Arthritis
- Radiology: Foot XRay
- Associated findings: Hindfoot Arthritis
- Calcaneonavicular coalition (best visualized on oblique AP film)
- Talocalcaneal coalition (observe for secondary signs on lateral film)
- Talar beaking (talar head with superior margin flaring)
- Lateral talar process with flattening and broadening
- Posterior talocalcaneal joint narrowing
- C-Sign (Medial outline of talar dome and posteroinferior outline of substentaculum tali)
- Absent middle Facet Sign (Subtalar joint middle facet is obscured on standing lateral view)
- Management
- Symptomatic
- Rest
- Heat
- NSAIDs
- Short Leg Walking Cast intermittently as needed
- Surgery often necessary
- Arthritis
- Arthrodesis of hindfoot and Tarsal Navicular
- Tarsal Coalition
- Bony and cartilaginous bar resection
- Arthrodesis of hindfoot and Tarsal Navicular
- Indicated for failed resection