title: Accessory anterolateral talar facet as an etiology of painful talocalcaneal impingement in the rigid flatfoot: a new diagnosis.
abstract: A retrospective review identified six patients with seven painful rigid flatfeet. In each case, pain was localized laterally to an accessory facet of the anterolateral talus. cross-sectional imaging demonstrated no evidence of tarsal coalition. In five of the six, preoperative magnetic resonance imaging (MRI) was obtained and in each case demonstrated focal abutting bone marrow edema consistent with impingement between the accessory facet and the anterior calcaneus.Seven feet in six patients underwent resection of the accessory facet with additional subtalar joint-sparing reconstructive procedures. At an average follow-up of 11 months, clinical results were graded as four good and two fair.An association between this accessory facet and pain in the rigid flatfoot has not been previously reported. Obesity was universal and may represent a risk factor for facet impingement. At early follow-up, facet resection with subtalar joint-sparing flatfoot reconstruction provided good results with symptomatic and functional improvement in the majority of patients.
authors.affiliation: Department of Orthopaedics and Rehabilitation, Vanderbilt University, Nashville, TN 37232-9565, USA. jeff.martus@vanderbilt.edu
authors.forename: Jeffrey E
authors.initials: JE
authors.lastname: Martus
authors.forename: John E
authors.initials: JE
authors.lastname: Femino
authors.forename: Michelle S
authors.initials: MS
authors.lastname: Caird
authors.forename: Lawrence R
authors.initials: LR
authors.lastname: Kuhns
authors.forename: Clifford L
authors.initials: CL
authors.lastname: Craig
authors.forename: Frances A
authors.initials: FA
authors.lastname: Farley
mesh_terms: D000293:Adolescent; D002111:Calcaneus / Q000473:pathology* / Q000601:surgery; D005260:Female; D005413:Flatfoot / Q000473:pathology* / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D010147:Pain Measurement; D012189:Retrospective Studies; D013380:Subtalar Joint / Q000473:pathology* / Q000601:surgery; D013628:Talus / Q000473:pathology* / Q000601:surgery; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome