Abstract：Objective This study aims to investigate the clinical effect of subtalar joint arthrodesis in treating accessory anterolateral talar facet (AATF) impingement syndrome (AATFIS) in adults with peroneal spasms. Methods Herein, a retrospective analysis was performed on the clinical data of 18 adult patients with AATFIS with peroneal spasm treated by subtalar joint arthrodesis in the Foot and Ankle Surgery Department of Xuzhou Central Hospital from March 2017 to April 2021, including 8 females and 10 males and the age ranged from 22 to 56 (42±11) year. Subtalar joint arthrodesis was performed in 18 patients, while tarsal sinus was cleared, and the accessory anterolateral talar facet was resected. In addition, peroneal brevis tendons lengthening was performed in seven patients with peroneal brevis contraction. During the operation, the weight bearing of the affected limb was simulated and alternated with the non-weight bearing. Meanwhile, the rotation of the subtalar joint and the impact of AATF on the calcaneal neck were observed under the two conditions. Moreover, the clinical effects were evaluated by the American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot function scale, visual analog scale (VAS) of pain, and the modified Ashworth muscle tone scale before and at the last follow-up. Results All 18 patients had large accessory anterolateral talar facet, and 13, 16, 7, and 11 of which had AATF cartilage injury, anterior talocalcaneal ligaments injury, talocalcaneal interosseous ligaments injury, and osteophyte hyperplasia around the accessory articular surface and calcaneal neck, respectively. The patients recovered well post-operation, and all surgical incisions healed by first intention. Afterward, all 18 patients were followed up for 11-43 (17.5±6.3) months. During the postoperative follow-up, imaging data of all patients showed good subtalar joint arthrodesis, and no nonunion cases were observed. Postoperative spasms were relieved, the arches were well recovered, the hindfeet alignments were good, and there was no obvious abduction of the midfoot. In comparison with preoperative, the AOFAS ankle-hindfoot function score increased [(84.6±6.2) vs. (33.8±6.7)], the VAS score decreased [1 (0, 2) vs. 7 (7, 8)], and the modified Ashworth scale decreased the peroneal muscle tone grade [grade 0 and grade 1 were 9 patients respectively vs. grade 3 in 6 patients and grade 4 in 12 patients] grades, the differences were statistically significant (t=27.65, Z=3.78, Z=3.84, all P values <0.05). Based on the AOFAS ankle-hindfoot function score, the curative effect was excellent, good, and fair in five, nine, and four cases, respectively. Conclusion Subtalar joint arthrodesis is a simple and effective method in treating AATFIS in adults with peroneal spasms.
陶友伦, 卜祥博, 常步青, 郝云甲, 张述才, 范家强, 吕泽祥, 张在轶, 王爱国. 距下关节融合治疗成人伴腓骨肌痉挛的距骨前外侧副关节面撞击综合征[J]. 中华解剖与临床杂志, 2023, 28(2): 98-103.
Tao Youlun, Bu Xiangbo, Chang Buqing, Hao Yunjia, Zhang Shucai, Fan Jiaqiang, Lyu Zexiang, Zhang Zaiyi, Wang Aiguo. Subtalar joint arthrodesis for the treatment of accessory anterolateral talar facet impingement syndrome in adults with peroneal spasm. Chinese Journal of Anatomy and Clinics, 2023, 28(2): 98-103.
Martus JE, Femino JE, Caird MS, et al.Accessory anterolateral facet of the pediatric talus. An anatomic study[J]. J Bone Joint Surg Am, 2008,90(11):2452-2459. DOI: 10.2106/JBJS.G.01230
[2]
Jibri Z, Foster R, Meulenkamp B, et al.Accessory anterolateral talar facet: analysis of the morphologic features on MRI[J]. Surg Radiol Anat, 2020,42(10):1145-1151. DOI: 10.1007/s00276-020-02435-5
[3]
Park JW, Park J, Park CH.Accessory talar facet impingement and sinus tarsi pain associated with accessory anterolateral talar facet[J]. Foot Ankle Int, 2021,42(8):1060-1067. DOI: 10.1177/10711007211002115
[4]
Martus JE, Femino JE, Caird MS, et al.Accessory anterolateral talar facet as an etiology of painful talocalcaneal impingement in the rigid flatfoot: a new diagnosis[J]. Iowa Orthop J, 2008,28:1-8
[5]
Niki H, Hirano T, Akiyama Y, et al.Accessory talar facet impingement in pathologic conditions of the peritalar region in adults[J]. Foot Ankle Int, 2014,35(10):1006-1014. DOI: 10.1177/1071100714540891
[6]
Alqahtani E, Fliszar E, Resnick DL, et al.Accessory anterolateral talar facet associated with tarsal coalition: prevalence and cross-sectional characterization[J]. Skeletal Radiol, 2020,49(3):417-424. DOI: 10.1007/s00256-019-03293-y
[7]
Vossen JA, Abbassi M, Qian Y, et al.Correlation between the accessory anterolateral talar facet, bone marrow edema, and tarsal coalitions[J]. Skeletal Radiol, 2020,49(5):699-705. DOI: 10.1007/s00256-019-03335-5
[8]
Johnson JC.Peroneal spastic flatfoot syndrome[J]. South Med J, 1976,69(6):807-809. DOI: 10.1097/00007611-197606000-00043
[9]
高正玉, 李富田, 魏芳远, 等. 腓骨肌痉挛性平足症的研究进展[J].足踝外科电子杂志,2019,6(4):58-62. DOI: 10.3969/j.issn.2095-7793.2019.04.013.Gao ZY, Li FT, Wei FY, et al.Research progress of spastic flatfoot of fibula[J]. Electronic Journal of Foot and Ankle Surgery,2019,6(4):58-62. DOI: 10.3969/j.issn.2095-7793.2019.04.013
[10]
Yang C, Huang Q, Cao Y, et al.Staged surgical management of sinus tarsi syndrome: our experience of 273 cases[J]. Ann Palliat Med, 2021,10(8):8909-8918. DOI: 10.21037/apm-21-1694
[11]
Harris RI, Beath T.Etiology of peroneal spastic flat foot[J]. J Bone Joint Surg Br, 1948,30B(4):624-634
[12]
Kurashige T. Accessory anterolateral talar facet impingement with tibialis spastic varus foot[J]. SAGE Open Med Case Rep, 2017,5:2050313X17745210. DOI: 10.1177/2050313X17745210
[13]
Shurnas PS, Coughlin MJ.Arthritic condition of the foot[M]//Coughlin MJ, Mann RA. Surgery of the foot and ankle. Philadelphia: Mosby Inc,2007:1073-1085
[14]
Akiyama K, Takakura Y, Tomita Y, et al.Neurohistology of the sinus tarsi and sinus tarsi syndrome[J]. J Orthop Sci, 1999,4(4):299-303. DOI: 10.1007/s007760050107
[15]
Kılıçoğlu Öİ, Salduz A, Birişik F, et al.High rates of psychiatric disorders and below normal mental capacity associated with spastic peroneal flatfoot: a new relationship[J]. J Foot Ankle Surg, 2018,57(3):501-504. DOI: 10.1053/j.jfas.2017.11.014
Niki H, Aoki H, Hirano T, et al.Peroneal spastic flatfoot in adolescents with accessory talar facet impingement: a preliminary report[J]. J Pediatr Orthop B, 2015,24(4):354-361. DOI: 10.1097/BPB.0000000000000178
[18]
陶友伦,郝云甲,张述才,等.距下关节镜下切除距骨前外侧副关节面治疗距骨前外,侧副关节面撞击综合征的效果观察[J].中华解剖与临床杂志, 2021,26(6):674-678. DOI:10.3760/cma.j.cn101202-20200918-00306.Tao YL, Hao YJ, Zhang SC, et al.Effect of subtalar arthroscopy for resection of accessory anterolateral talar facet in the treatment of accessory anterolateral talar facet impingement syndrome[J].Chin J Anat Clin,2021,26(6):674-678. DOI:10.3760/cma.j.cn101202-20200918-00306
[19]
Orhurhu V, Urits I, Orman S, et al.A systematic review of radiofrequency treatment of the ankle for the management of chronic foot and ankle pain[J]. Curr Pain Headache Rep, 2019,23(1):4. DOI: 10.1007/s11916-019-0745-5
[20]
Dellon AL, Barrett SL.Sinus tarsi denervation: clinical results[J]. J Am Podiatr Med Assoc, 2005,95(2):108-113. DOI: 10.7547/0950108
[21]
Xu J, Muhammad H, Wang X, et al.Botulinum toxin type a injection combined with cast immobilization for treating recurrent peroneal spastic flatfoot without bone coalitions: a case report and review of the literature[J]. J Foot Ankle Surg, 2015,54(4):697-700. DOI: 10.1053/j.jfas.2014.03.008
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