Tarsal Coalition and Painful Flat Foot Fixed with Evans Osteotomy


This 13 yo female was referred due to chronic foot pain, fatigue and “toe walking”. Pt had complaints of inability to participate in athletics due to pain, and fatigue in her feet. Pt had hx of non-op tibial shaft fracture which was accredited with causing tight posterior muscle group due to serial casting.

Pt failed conservative measures, mainly physical therapy to adequately restore appropriate dorsiflexion at the tibiotalar joint.

Her hindfoot motion was abnormal, and sinus tarsi was chronically painful on exam.

Plain film was interpreted by non-MSK radiology as “normal”. A CT was ordered to further eval the coalition observed. …. And rule out pathology within the STJ.

In order, we performed Coalition resection, Evans osteotomy, and Tendo Achilles lengthening.

After the Evans is performed if no forefoot supinatus is appreciated, and looking down the “gun barrel” yields a 1st ray that looks fairly even with the 5th ray, a Cotton osteotomy is not necessary.

At 10wks from date of surgery the patient is having no further symptoms, and is back in sneakers. She is looking forward to potentially participating in sports this fall.

***Extremity Medical Non-cortical allograft wedge and staples used for the Evans