Barroso J L, Barriga A, Barrecheguren E G, Villas C, Beguiristáin J L
Departamento de Cirugía Ortopédica y Traumatología, Clínica Universitaria, Facultad de Medicina, Universidad de Navarra.
Rev Med Univ Navarra. 2001 Jan-Mar;45(1):43-52.
The incidence of congenital tarsal coalition is about 1%. It is recognized as the main etiology of painful, rigid flatfoot in the pediatric population. Talonavicular (50%) and talocalcaneal (40%) coalition are the most common presentation. We must suspect a tarsal coalition in a child with mechanical pain and shoes deformity. Rigid and painful planovalgus deformity are found in physical exam which led to describe in the pass this entity as peroneal spastic flatfoot. Lateral and oblique (35 degrees-45 degrees) radiographs must be practice to observe the coalition. The presence of a beak in the head of the talus or a half moon condensation image as the result of the superposition of the talus over the calcaneus are commonly described. CT-scan is also useful to delineate the size of the coalition and its location. Resection of the bar is the surgical treatment of choice. Excision of the coalition and interposition of fat or a graft must be tried in young patients in order to preserve foot biomechanical properties and to avoid long term problems associated with arthrodesis. Triple arthrodesis or subtalar arthrodesis must be used in older patients with degenerative signs in radiographs or in those cases of multiple coalition or if resection has failed.
先天性跗骨融合的发病率约为1%。它被认为是小儿人群中疼痛性僵硬扁平足的主要病因。距舟（50%）和距跟（40%）融合是最常见的表现形式。对于有机械性疼痛和足部畸形的儿童，我们必须怀疑有跗骨融合。体格检查发现僵硬且疼痛的扁平外翻畸形，过去曾将此病症描述为腓骨痉挛性平足。必须拍摄侧位和斜位（35度至45度）X线片以观察融合情况。常见的表现是距骨头处有喙状突起或由于距骨与跟骨重叠而形成的半月形致密影像。CT扫描对于确定融合的大小及其位置也很有用。切除骨桥是首选的手术治疗方法。对于年轻患者，必须尝试切除融合并植入脂肪或移植物，以保持足部生物力学特性并避免与关节融合相关的长期问题。对于X线片有退变征象的老年患者、多处融合的病例或切除失败的情况，必须采用三关节融合术或距下关节融合术。
