Kulik S A, Clanton T O
University of Texas, School of Medicine at Houston, USA.
Foot Ankle Int. 1996 May;17(5):286-96. doi: 10.1177/107110079601700509.
Tarsal coalition is a bridging between the tarsal bones of the foot. The bridge may be composed of bone, cartilage, fibrous tissue, or a combination of these. When symptomatic, patients usually present with hindfoot pain and frequent sprains as children, adolescents, or young adults. The classical appearance is a rigid flatfoot with heel valgus and abduction of the forefoot. Flexible cavus feet have been reported. The incidence in the general population is less than 1%, and the most common types are talocalcaneal and calcaneonavicular coalitions. The cause is attributed to failure of segmentation and differentiation of the primitive mesenchyme. Calcaneonavicular coalitions can be diagnosed with an oblique radiograph of the hindfoot. Most talocalcaneal coalitions require computerized tomography for diagnostic confirmation. Magnetic resonance Imaging may be useful for cartilaginous and fibrous coalitions. Casting is the usual initial treatment for the symptomatic individual. With treatment failure, in the absence of degenerative changes, resection of the coalition can be performed with good results. Isolated subtalar fusion may be performed for failed talocalcaneal resections. Failed subtalar fusions and failed calcaneonavicular resection may be treated with triple arthrodesis.
跗骨联合是足部跗骨之间的连接。这种连接可能由骨、软骨、纤维组织或它们的组合构成。出现症状时，患者通常在儿童、青少年或年轻成人时期表现为后足疼痛和频繁扭伤。典型表现为僵硬扁平足，伴有足跟外翻和前足外展。也有报道称存在柔性高弓足。一般人群中的发病率低于1%，最常见的类型是距跟和跟舟联合。病因归因于原始间充质的节段化和分化失败。跟舟联合可通过后足斜位X线片诊断。大多数距跟联合需要计算机断层扫描来确诊。磁共振成像对软骨性和纤维性联合可能有用。对于有症状的个体，通常首先采用石膏固定治疗。若治疗失败，在无退行性改变的情况下，可进行联合切除术，效果良好。对于距跟切除失败的情况，可进行单纯距下关节融合术。距下关节融合失败和跟舟切除失败可采用三关节融合术治疗。
