From the Research
Resection is the preferred treatment for symptomatic talocalcaneal or calcaneonavicular coalitions, particularly in younger patients without significant degenerative changes, as it preserves joint mobility and typically results in good pain relief with shorter recovery times. When comparing post-operative outcomes for tarsal coalitions, resection generally produces better functional results than arthrodesis, especially in patients with less than 50% involvement of the joint surface and no advanced arthrosis 1, 2. The procedure involves removing the coalition and interposing soft tissue (fat, tendon, or muscle) to prevent recurrence. Post-operatively, patients typically require 4-6 weeks of non-weight bearing in a cast, followed by progressive weight bearing in a walking boot and physical therapy focusing on range of motion and strengthening exercises.
Some key points to consider when deciding between resection and arthrodesis include:
- Patient's age: younger patients tend to have better outcomes with resection
- Coalition size and location: larger coalitions or those involving more than 50% of the joint surface may require arthrodesis
- Presence of degenerative changes: advanced arthrosis may necessitate arthrodesis
- Activity goals: patients who want to maintain athletic activities may prefer resection to preserve joint mobility
Arthrodesis (fusion) is generally reserved for cases with advanced arthritic changes, failed previous resection, or large coalitions involving more than 50% of the joint surface 3, 4. While arthrodesis provides reliable pain relief, it permanently eliminates motion at the fused joint, potentially increasing stress on adjacent joints and leading to long-term complications. A study published in 2021 found that resection is the treatment of choice for symptomatic tarsal coalitions, as it restores mobility and reduces the risk of subsequent degenerative arthritis 1. Another study published in 2020 recommended resection for calcaneonavicular coalitions and selected talocalcaneal coalitions, reserving arthrodesis for cases with advanced arthrosis or significant hindfoot malalignment 2.
In terms of post-operative outcomes, a study published in 2016 found that resection with silicone sheet interposition resulted in good clinical and radiologic outcomes in children with symptomatic tarsal coalitions, with no recurrence of the coalition observed at follow-up 5. Overall, the choice between resection and arthrodesis should be individualized based on the patient's specific condition and goals, with resection being the preferred treatment for most cases of symptomatic talocalcaneal or calcaneonavicular coalitions.