1/2. Tarsal coalitions: review of the literature and case report of bilateral dual calcaneonavicular and talocalcaneal coalitions.Inasmuch as midfoot coalitions do not occur frequently, a preadolescent or early adolescent patient who has persistent complaints of painful flat foot with peroneal or anterior tibial muscle spasm warrants special evaluation. The patient may complain of becoming easily tired or report the onset of pain with increased activity. Clinical examination may reveal local tenderness over the area of the coalition, but this is not a consistent finding. Restricted inversion of the foot with spasm of the peroneals, forefoot abduction or pronation should alert the examining physician that a tarsal coalition may be present. Appropriate roentgenograms examining all of the possibly involved joints should be obtained. These include 45 degrees oblique views of the foot, which usually give a satisfactory view of the calcaneonavicular joint. Coalitions may occur in any of the facets of the talocalcaneal joint and therefore all facets must be evaluated. The anatomic location of the facets can be variable and multiple-angle axial views may be required. We recommend a 45 degrees axial view to visualize the posterior and middle facets, since they are normally parallel in the axial view. If fibrous coalitions are present, the middle facet may be oblique. tomography is necessary to visualize the anterior facet or to confirm a coalition either in the middle or in the posterior facets.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/2. Examination and management of a patient with tarsal coalition.The purpose of this case report is to illustrate how the literature can be used to guide clinical decisions related to a relatively uncommon pathological condition of the foot. This case report describes the approach used to examine and treat a 14-year-old boy referred by a physician for physical therapy with a diagnosis of peroneal spastic flatfoot (PSFF). Peroneal spastic flatfoot is a syndrome typically characterized by limited tarsal joint motion, a clonus response of the evertors, and a pes planus deformity. The patient reported having a limp for several years, but he said he was pain-free until he had an inversion injury of his foot. Because the physical therapists had not seen a patient with a diagnosis of PSFF, they reviewed the literature related to PSFF. They describe how their review enhanced their understanding of PSFF and how PSFF is related to the diagnosis of tarsal coalition, a pathological condition eventually identified in this child. Following 5 unsuccessful physical therapy sessions, they referred the patient to another physician who diagnosed a talocalcaneal coalition, a type of tarsal coalition.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |