Failed Flat Foot Surgery — Failed Tarsal Coalition Resection Revised


23 yo male had a previous extra-articular, or FLEXIBLE flat foot recon (elsewhere) with a gastroc recession, anterior calc osteotomy and a Kidner. It was reported the patient also had a CN bar coalition resection.

Unfortunate for this patient a TC coalition was not identified pre or intra-operatively. Additionally, the CN bar was not fully excised either. This patient’s foot was not flexible.

3 years after this young man had his index surgery he was miserable, and did not understand why.

We repeated MRI imaging & discovered the 2nd coalition. The under resected CN was noted on plain film prior to MR.

We had careful discussion with patient that due to the lack of flexibility of his hindfoot articulations, these joint sparing procedures were not appropriate. To definitively treat his pain, and improve alignment a fusion would need to be performed.

We thankfully were able to resect both coalitions through standard ST approach. We felt removing the Evans wedge didn’t provide any benefit to the patient. Additionally, patient was in severe equinus again so we elected to lengthen again with a TAL.

Pt is now 12 weeks post op as pictured in xrays and very happy.

Shoutout to @gitasreeb for being an incredible MSK radiologist.

Extremity Medical hardware used to revise this case.