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Arthroscopic resection of the calcaneonavicular coalition or the "too long" anterior process of the calcaneus.
Lui TH. Arthroscopy. 2006 Aug;22(8):903.e1-4.
Quote:
Calcaneonavicular coalition and the "too long" anterior process (TLAP) of the calcaneus can manifest as lateral foot pain, peroneal spastic flatfoot, and repeated ankle sprain. Surgical resection of the bone bar is frequently required. We present here an arthroscopic approach that can be used to accurately assess pathoanatomy and resect the bone bar. A portal is established slightly dorsal to the angle of Gissane. This is the primary visualization portal. The working portal, which is identified under an image intensifier, is located at the space between the talonavicular and calcaneocuboid joints, directly over the TLAP or the calcaneonavicular coalition. With the 2.7-mm 30 degrees arthroscope placed at the primary visualization portal, soft tissue around the TLAP or the calcaneonavicular coalition is cleared up with the use of an arthroscopic shaver at the working portal. After the TLAP or the calcaneonavicular coalition is clearly visualized, it can be resected with an arthroscopic burr through the working portal. The bone bar is resected proximally until the medial side of the calcaneocuboid joint, the lateral side of the taloavicular joint, and the plantar-lateral aspect of the talar head are clearly seen. Inversion stress should then be applied to the foot to prevent further impingement of the anteromedial process of the calcaneus to the plantar-lateral part of the talar head.
A too-long anterior process of the calcaneus is one of the causes of repeated sprained ankles or painful feet in the child or adolescent that is often ignored and misdiagnosed. Among 31 cases of adolescents having consulted for these symptoms, a too-long anterior process of the calcaneus was discovered on radiographs, and explored in detail with a computed tomography scan or an MRI. The decision for surgical resection was taken considering the discomfort expressed by these children. The intraoperative observation corroborated the radiological findings and permitted a better understanding of the mechanisms responsible for the pain, the repeated sprained ankles and other instabilities. The surgical resection, which is a simple procedure, gave very good results. One must nevertheless be aware of the possible secondary lesions because of repeated sprained ankles: breakage of the lateral ligaments of the ankle and external malleolus nonunion or talus osteochondritis, which can compromise the operation's result, if they are not treated simultaneously.
TLAP = "too long" anterior process of calcaneus
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