Calcaneonavicular Coalition Resection With Pes Planovalgus Reconstruction.

Abstract

Calcaneonavicular coalitions can lead to a painful, rigid pes planovalgus deformity. Historical treatment of coalitions recommends resection. A newer concept in coalition treatment includes concomitant flatfoot reconstruction. In the present study, we hoped to demonstrate the ability to reconstruct a flatfoot deformity with concomitant calcaneonavicular coalition resection. We performed a retrospective comparative study of patients undergoing isolated calcaneonavicular bar excision (group A) with those undergoing calcaneonavicular bar excision and concomitant pes planovalgus reconstruction (group B). The radiographic parameters of pes planovalgus correction were measured on the pre- and postoperative radiographs, including talar head uncoverage, calcaneal inclination, and anteroposterior and lateral talo-first metatarsal angle. Calcaneonavicular coalition resection was performed using a standard technique with or without biologic spacers. Associated flatfoot reconstruction included posterior muscle group lengthening, calcaneal osteotomy, and/or midfoot osteotomy. Of the 27 patients, 20 were included in group A and 7 in group B. Their mean age was 18.1 years. Improvement was seen in the radiographic parameters for patients undergoing calcaneonavicular bar excision with concomitant flatfoot procedures, with statistical significance found in the calcaneal inclination (p = .013). Talar head uncoverage improved in both groups (p = .011). No change was found in the radiographic angles in patients undergoing isolated calcaneonavicular bar excision. No patients in either group developed recurrence of the coalition. The results of the present study demonstrated radiographic improvement in patients undergoing calcaneonavicular bar excision with concomitant pes planovalgus reconstruction. Hindfoot reconstruction with joint sparing osteotomies during coalition excision is a reasonable option to improve alignment and avoid arthrodesis.