Operative versus nonoperative treatment in children with painful rigid flatfoot and talocalcaneal coalition

摘要

Illustrations of the surgical technique step by step. A medial approach is performed with an incision over the sustentaculum tali, centered to the coalition. The tibialis posterior tendon is retracted dorsally, while flexor hallucis longus and the flexor digitorum longus tendons are retracted plantarly, exposing the bone bridge. After the identification of the talonavicular joint anteriorly and the residual talocalcaneal joint posteriorly, the bridge is excised using osteotomes. The joint is open with a spreader, gaining the separation and complete motion of the talocalcaneal joint. A lateral incision is performed over the sinus tarsi, exposing the lateral facet of the talus. A frozen fascia lata allograft is folded in two layers before positioning. The fascia lata allograft is passed from lateral to medial into the tarsal canal and the two layers of the graft are placed covering the bony surfaces of the resected area. The edges of the graft are fastened with suture anchors or absorbable stitches. A calcaneo-stop screw is inserted in the talus to keep the correction