Search Our Scientific Publications & Authors

J Pediatr Orthop 2022 Jul 10;42(6):e612-e615. Epub 2022 Mar 10.

Division of Pediatric Orthopedic Surgery, Hospital for Special Surgery, New York, NY.

Background: The size of talocalcaneal tarsal coalitions (TCCs) is one of the main factors that is thought to influence patient outcomes after resection. Magnetic resonance imaging (MRI) is increasingly being used to diagnose and characterize TCCs. However, there is no reproducible MRI-based measurement of TCC size reported in the literature. Read More

Arthrosc Tech 2022 Apr 21;11(4):e491-e495. Epub 2022 Apr 21.

Department of Orthopaedic Surgery, Flinders University and Flinders Medical Centre, Adelaide, South Australia.

Carpal coalition is a rare condition caused by a failure in the process of apoptosis. It is often incidentally diagnosed and seldomly symptomatic. The lunotriquetral joint is the most commonly affected joint, accounting for 90% of carpal coalitions. Read More

J Am Acad Orthop Surg 2022 Apr 26. Epub 2022 Apr 26.

From the OrthoCarolina Foot and Ankle Institute, Charlotte, NC (Ford), Orthopedic Associates of Dallas, Baylor Scott & White, Dallas, TX (Zide), and the Texas Scottish Rite Hospital for Children, Dallas, TX (Zide and Riccio).

While flatfeet are normal in children, persistence into adolescence with associated pain or asymmetry warrants additional evaluation. Rigidity of a flatfoot deformity, whether a clinical report or evident on examination, should raise suspicion for pathology. The differential diagnosis includes tarsal coalition, neurogenic planovalgus, and peroneal spasticity. Read More

J Pediatr Orthop 2022 Jul 27;42(6):321-326. Epub 2022 Apr 27.

Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee Health Science Center-Campbell Clinic, Le Bonheur Children's Hospital.

Background: Newer cone-beam computed tomography (CT) technology has grown in popularity for evaluation of foot and ankle pathology in the weight-bearing (WB) position. Many studies have demonstrated its benefits within the adult population, but there is a paucity of its use within the pediatric literature. The purpose of this study was to describe the indications and clinical findings of WBCT within a pediatric population. Read More

Clin Anat 2022 Apr 6. Epub 2022 Apr 6.

Department of Radiology, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey.

We aimed to investigate the bone and soft tissue changes accompanying tarsal coalition (TC) and aimed to evaluate their association with the location and type of coalition. Ankle magnetic resonance imagings of 65 patients with TC were included. The relationship between the location and type of coalition and bone marrow edema, subchondral cysts, sinus tarsi syndrome, tarsal tunnel syndrome, posterior impingement syndrome, accessory bone, tibiotalar effusion, talar osteochondritis dissecans, ganglion cysts, and calcaneal spur were evaluated. Read More

Jt Dis Relat Surg 2022 28;33(1):245-248. Epub 2022 Mar 28.

Karabük Üniversitesi Tıp Fakültesi, Ortopedi ve Travmatoloji Anabilim Dalı, 78100 Karabük, Türkiye.

The association of accessory anterolateral talar facet (AALTF) and tarsal coalition has been reported recently. However, there is no report in the literature examining the clinical outcomes of operative treatment simultaneously addressing both AALTF and tarsal coalition. In this case series, we report the functional outcomes of operative treatment for both AALTF and calcaneonavicular coalition (CNC). Read More

J Pediatr Orthop 2022 May-Jun 01;42(5):e453-e458

Scottish Rite Hospital for Children, Dallas, TX.

Purpose: While intra-articular steroid injection has been used anecdotally in patients with symptomatic talocalcaneal coalitions recalcitrant to traditional conservative modalities, the ability of this treatment to provide symptomatic relief and obviate or delay surgical intervention remains unknown. The purpose of this study is, therefore, to assess the treatment efficacy of intra-articular subtalar steroid injection in children with symptomatic talocalcaneal coalitions.

Methods: A retrospective study of all patients with isolated subtalar coalitions was performed at a single pediatric orthopaedic institution over a 30-year period. Read More

Iowa Orthop J 2021 12;41(2):6-11

Department of Orthopedics, Aalborg University Hospital, Aalborg, Denmark.

Background: Patient Reported Outcome Measures (PROM) after resection of tarsal coalitions are sparse. This cross-sectional study evaluates the outcome after resection of tarsal coalitions in children using the validated Oxford Foot and Ankle Questionnaire (OxAFQ).

Methods: Tarsal coalition patients between 5-16 years of age from Aarhus University Hospital (Denmark) and The Royal London Hospital (United Kingdom) were included. Read More

Br J Radiol 2022 Apr 5;95(1132):20210784. Epub 2022 Jan 5.

Department of Radiology, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, UK.

Objective: To determine the additional benefit of MRI for children with flatfoot deformity assessed with weight-bearing radiographs in a specialist paediatric orthopaedic unit.

Methods And Materials: Patient cohort was obtained by searching the Radiology Information System for children referred for investigation of flatfoot. All patients with flatfoot on weight-bearing radiographs who had undergone MRI were included. Read More

Clin Podiatr Med Surg 2022 Jan;39(1):129-142

Department of Surgery, Cambridge Health Alliance, Harvard Medical School, 1493 Cambridge Street, Cambridge, MA 02139, USA.

Tarsal coalitions are recognized as a congenital anomaly whereby the two or more bones of the hindfoot and midfoot are fused resulting in limitation of foot motion and pain. Tarsal coalitions were found to be the cause of painful flatfeet in adolescents and young adults. Developing a clinical understanding of tarsal coalitions as well as developing a step-wise conservative and surgical approach for their treatment can alleviate patient symptomatology and provide excellent long-term benefits. Read More

Foot Ankle Clin 2021 Dec 30;26(4):941-954. Epub 2021 Aug 30.

Department of Orthopaedic Surgery, University of Colorado, Denver, CO, USA.

Complex tarsal coalition includes extensive talocalcaneal coalition, double or triple coalition, coalition with severe hindfoot deformities, or coalition with a ball-and-socket ankle deformity. Careful preoperative physical examination including diagnostic injection is important in treatment planning. Both radiographic examination and computed tomographic scan that involve not only the foot but also the ankle are necessary to analyze the location and size of the coalitions, determining the presence of arthritis in the involved or adjacent joints, and if there are any deformities including a ball-and-socket ankle, which is frequently associated with complex tarsal coalitions. Read More

Foot Ankle Clin 2021 Dec 4;26(4):873-901. Epub 2021 Oct 4.

Head Pediatric Orthopedic and Traumatology Unit, San Raffaele Hospital, Via Olgettina 60, Milan 20132, Italy. Electronic address:

Tarsal coalition is determined by an absence of segmentation between one or more foot bones. The main symptom is activity-related foot pain, usually dorsolateral for calcaneonavicular coalitions and medial for talocalcaneal ones. At presentation, a symptomatic tarsal coalition must be treated conservatively for at least 6 months. Read More

JBJS Case Connect 2021 10 27;11(4). Epub 2021 Oct 27.

Department of Orthopaedics, Rutgers New Jersey Medical School, New Jersey.

Case: Tarsal-carpal coalition syndrome (TCCS) is a disorder identified by fusion of the carpals, tarsals, and phalanges of the hands and feet. We describe a case of an 11-year-old girl who has been followed at our outpatient clinic from the age of 8 months.

Conclusion: Although patients with TCCS can experience a wide range of symptoms, the primary complaint arises from the foot deformity and associated pain. Read More

Skeletal Radiol 2022 Jun 13;51(6):1115-1125. Epub 2021 Oct 13.

University of Missouri, Hospital Drive, Columbia, MO, 65212, USA.

The purpose of this article is to focus attention on the abnormalities which the radiologist may encounter in patients presenting with lateral ankle or foot pain outside of the context of acute trauma. These include anterolateral impingement, subfibular impingement, subtalar instability and tarsal sinus syndrome, tarsal coalition, sural neuromas, peroneal tendon abnormalities, calcaneocuboid instability and occult cuboid fractures, and painful accessory ossicles. The expected and unexpected findings on radiographs, CT, US, and MRI are discussed. Read More

Genes (Basel) 2021 08 29;12(9). Epub 2021 Aug 29.

Ingham Institute, School of Psychiatry, University of NSW, Sydney, NSW 2170, Australia.

Multiple synostoses syndrome type 4 (SYNS4; MIM 617898) is an autosomal dominant disorder characterized by carpal-tarsal coalition and otosclerosis-associated hearing loss. SYSN4 has been associated with GDF6 gain-of-function mutations. Here we report a five-generation SYNS4 family with a reduction in expression resulting from a chromosomal breakpoint 3' of . Read More

Skeletal Radiol 2022 May 24;51(5):991-996. Epub 2021 Sep 24.

Departments of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Bristol Road South, Birmingham, B21 3AP, UK.

Objective: To highlight causal relationship between stress fracture in the presence of tarsal coalition and hindfoot pain in adolescents on magnetic resonance imaging (MRI).

Material And Methods: A retrospective review was performed of the clinical and MRI imaging findings of 6 adolescents referred for MRI to evaluate symptoms of hindfoot pain with possible tarsal coalition. MRI studies were systematically assessed for cause of hindfoot pain, types of tarsal coalition, patterns of stress fractures, bone marrow oedema and any other associated features. Read More

J Pediatr Orthop 2021 Oct;41(9):e828-e832

Departments of Orthopaedic Surgery.

Background: Excision of pediatric tarsal coalition has been successful in most patients. However, some patients have ongoing pain after coalition excision. This study prospectively assessed patient-based clinical outcomes before and after surgical excision of tarsal coalition, with particular emphasis on comparison to radiologic imaging. Read More

J Pediatr Rehabil Med 2021 ;14(3):361-369

Universitary Hospital Necker Enfants Malades, Orthopaedic Department, Paris, France.

Purpose: Multiple synostoses syndrome (MSS) is a rare genetic condition. Classical features consist of joint fusions which notably start at the distal phalanx of the hands and feet with symphalangism progressing proximally to carpal, tarsal, radio-ulnar, and radio-humeral joints, as well as the spine. Usually, genetic testing reveals a mutation of the NOG gene with variable expressivity. Read More

J Foot Ankle Surg 2021 Sep-Oct;60(5):876-880. Epub 2021 May 26.

Assistant Professor, Mechanical Engineering Department, Binghamton University, Binghamton, NY.

Recent literature has proposed that restriction of joints in the rearfoot secondary to coalitions may lead to increased risk for severe ankle fracture after trauma. There is a paucity of literature regarding the rigidity of the ankle joint after arthrodesis of the subtalar and talonavicular joints. In this study, load-to-failure testing of cadaveric ankle joints with and without fusion of the subtalar and talonavicular joints was performed to determine if clinically relevant fracture patterns could be reproduced. Read More

Skeletal Radiol 2022 Jan 23;51(1):191-200. Epub 2021 Jun 23.

Department of Radiology, UC San Diego Health, 200 W. Arbor Drive, #8226, San Diego, CA, 92103, USA.

Objective: Tarsal coalition is known to cause abnormal talocrural stress, hindfoot malalignment, and ankle sprains. These can all be associated with osteochondritis dissecans (OCD) of the talar dome. We present the first detailed description of a series of talar OCDs occurring in patients with tarsal coalition, with the goal of determining whether there is an increased prevalence of OCDs among patients with tarsal coalition. Read More

Rev Esp Cir Ortop Traumatol (Engl Ed) 2021 Jun 12. Epub 2021 Jun 12.

Facultad de Medicina, Universidad de Valencia, Valencia, España.

Background And Objective: The tarsal coalition can be a cause of mid-hindfoot pain in older children. The objective is to analyze the types of coalition treated in our hospital from 2010 to 2019 as well as the treatment carried out.

Material And Method: Observational, descriptive and retrospective study of 18 patients with tarsal coalition, 8 women and 10 men, aged 11. Read More

J Foot Ankle Surg 2021 Sep-Oct;60(5):1073-1078. Epub 2021 Apr 20.

Department of Orthopedics, the First Hospital of China Medical University, Shenyang, Liaoning Province, China. Electronic address:

Pseudomyogenic hemangioendothelioma is a rare soft tissue tumor most often found in the lower extremities and predominantly occurring in males. The talocalcaneal coalition is an anatomic anomaly that develops between the talus and calcaneus bones, can cause hindfoot pain and subtalar joint stiffness, and has a prevalence of less than 1%. We present what is to our knowledge the first case report of a 17-year-old male with pseudomyogenic hemangioendothelioma occurring within a talocalcaneal coalition. Read More

Foot Ankle Int 2021 Aug 22;42(8):1060-1067. Epub 2021 May 22.

Department of Orthopedic Surgery, College of Medicine, Yeungnam University, Daegu, Korea.

Background: Sinus tarsi pain caused by accessory talar facet impingement (ATFI) owing to accessory anterolateral talar facet (AALTF) is not well documented. We evaluated prevalence of AALTF and differences of magnetic resonance imaging (MRI) findings between persons with and without sinus tarsi pain, and investigated the relevant association between MRI findings and sinus tarsi pain in persons with AALTF.

Methods: We performed a case-control study on 120 ankles with sinus tarsi pain and 120 age- and gender-matched ankles without sinus tarsi pain. Read More

Skeletal Radiol 2021 Nov 17;50(11):2133-2149. Epub 2021 May 17.

Department of Radiology, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP, Middlesex, UK.

Flatfoot is commonly encountered in the paediatric population and describes a spectrum of clinical and radiological presentations which encompass both normally developing and pathological feet. Flatfoot can be categorised as flexible or rigid, a distinction which has important implications when considering the potential underlying aetiology and treatment options, and therefore imaging is an important component of the diagnostic workup. Weight-bearing plain radiographs are established initial investigations, although the significance of a number of the commonly derived quantitative parameters in children remains unclear. Read More

Foot (Edinb) 2021 Jun 8;47:101797. Epub 2021 Apr 8.

Northwestern Memorial Hospital, Chicago, IL, USA.

Displaced isolated fractures of sustentaculum tali are rare. Inadequate treatment of these injuries can rarely lead to non-union or mal-union and in most cases are treated non-surgically. We report a unique case of undiagnosed mal-union of sustentaculum tali in the setting of underlying tarsal coalition that resulted in symptoms of tarsal tunnel. Read More

JBJS Case Connect 2021 03 24;11(1):e20.00360. Epub 2021 Mar 24.

Division of Pediatric Orthopedic Surgery, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York.

Case: An 11-year-old boy demonstrated chronic medial hindfoot pain. A 12-year-old boy experienced acute pain and swelling in his right medial ankle and hindfoot after a fall. This is the first report of sustentaculum tali fractures adjacent to a talocalcaneal tarsal coalition, likely resulting from a stress riser created by a rigid subtalar joint. Read More

JBJS Case Connect 2021 01 14;11(1):e19.00404. Epub 2021 Jan 14.

Department of Orthopaedics and Sports Medicine, Temple University Hospital, Philadelphia, Pennsylvania.

Case: Tarsal coalitions are relatively common, but there are no reports of cuneiform-to cuneiform coalition in the English language literature. The authors present a case of medial-to-intermediate cuneiform coalition in a young female track athlete. Previous nonoperative treatments had been unsuccessful. Read More

J Foot Ankle Surg 2021 Mar-Apr;60(2):228-232. Epub 2021 Jan 16.

Surgeon, Orthopaedic Surgery Department, Vall Hebron Barcelona Hospital Campus, Universistat Autonoma de Barcelona, Barcelona, Spain.

Persistent symptomatic calcaneonavicular coalition (CNC) and too-long anterior process of the calcaneus (TLAP) are congenital disorders that can benefit from surgical treatment. The arthroscopic technique for CNC and TLAP resection has previously been described. The aim of this prospective study was to describe outcomes following arthroscopic resection of 12 (38. Read More

Foot (Edinb) 2021 Mar 13;46:101752. Epub 2021 Jan 13.

Kent State University College of Podiatric Medicine, 6000 Rockside Woods Blvd. Independence, OH 44131, United States. Electronic address:

Objective: The C-sign on lateral radiographs has been subject to considerable debate with respect to its reliable association to subtalar joint tarsal coalition. The purpose of this study was to determine to what degree subtalar joint pronation factors into (a) the appearance of both complete and incomplete type A C-signs and (b) the conspicuity of the middle facet in both flatfeet and rectus feet.

Study Design: Forty-seven normal adult volunteers were enrolled into the study with a total of 92 feet, of which 42 were flexible flatfeet and 50 were rectus feet with normal subtalar joint range of motion. Read More

J Child Orthop 2020 Oct;14(5):433-439

Departments of Orthopaedics, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.

Purpose: This study was designed to review the diagnostic yield of single photon emission computed tomography-computed tomography (SPECT/CT) in children with complex foot/ankle pain.

Methods: We reviewed the records of 33 patients with complex foot and ankle pain referred for SPECT/CT (36 scans) performed between 1st September 2009 to 30th September 2019. All patients had foot and ankle radiographs and 18 out of 33 patients had undergone magnetic resonance imaging (MRI) prior to SPECT/CT. Read More