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Table 4 The summarized results of systematic literature review of selected papers. Case reports with less than 3 cases were not reported

From: Operative versus nonoperative treatment in children with painful rigid flatfoot and talocalcaneal coalition

Author, YearN° Patients (N° feet)Mean age at TreatmentType of treatmentFollow-up (years)Rate of good/excellent resultsComplications/recurrence
Swiontkowski, 1983 [39]10 (10)11–45Resection (4)
Fusion (6)
100%none
Elkus, 1986 [40]8 ft13 (8–19)resection2 (1–7)8/8 (100%)none
Olney, 1987 [33]9 (10)14 (10–22)Resection + fat interposition3.38/10 cases (80%)1 patient had further surgery for incomplete resection
Scranton, 1987 [41]14 (23)24 (11–55)Cast immobilization (5)
Resection (14)
Fusion (4)
3.9 (2.2–9.5)23/23 (100%)none
Danielsson, 1987 [42]3 (3)Resection + fat interposition1.5–14100%none
Takakura, 1991 [43]42 (67)17.3 (5–54)a) Nonoperative treatment: 24 (33)
b) Operative treatment:
1. resection: 26 (33)
2. fusion: 3 (3).
5.3 (2–11.2)a) Nonoperative treatment: 68%
b) Operative treatment: 83%
a) Nonoperative treatment: residual pain in 8 ft (26%) limited motion in nine feet (29%)
b) Operative treatment:
mild residual pain in 4/33 ft treated by excision of the coalition (12%)
subtalar motion unchanged or decreased in 7/30 ft treated by excision of the coalition (23%)
sensory disturbance of the sole in 3/14 ft treated by excision of the coalition (21%)
No complications reported in patients treated by subtalar fusion
Salomao, 1992 [44]22 (32)14 (10–23)resection + fat interposition.2 (1–5.5)78% of feet became completely painless and 22% achieved relief of pain.
Improved deformity in 69%
Improved range of motion in 75%.
none
Kumar, 1992 [45]16 (18)14 (7–19)a) resection (3 cases)
b) resection + fat interposition (6 cases)
c) resection + split flexor hallucis longus tendon interposition (9 cases)
4 (2–8)12/14 (87.5%)1 relapse of the coalition with poor clinical outcome
Wilde, 1994 [19]17 (20)13 (9–15)Resection.1–910/20 (50%)Residual RFF in 10/20 ft
(50%)
Kitaoka, 1997 [46]11 (14)17 (13–32)a) resection (9 cases)
b) resection + fat or split flexor hallucis longus tendon interposition (5 cases)
6 (2–13)9/14 (64%)none
McCormack,1997 [47]8 (9)13.6 (10.5–22)Resection + fat interposition11.5 (10–16)7/9 (78%)none
Comfort, 1998 [48]16 (20)14 ± 2Resection2.4 (2–6.2)12/20 (60%)Four (20%) patients underwent further surgery.
Dutoit, 1998 [49]8 (9)14.1Resection4.5 (3–11.3)4/8 (50%)none
Luhmann, 1998 [50]20 (25)12.5 (9–16)Resection + fat interposition2.5 (1–8)19/25 (76%)2 superfical infection
2 coalition reformation.
5 cases had further surgery (peroneal tendon lengthening, 1 lateral column lengthening 3 arthrodesis)
Raikin, 1999 [51]10 (14)12 (9–16)Resection + split flexor hallucis longus tendon interposition4.2 (2.7–5)12/14 (86%)none
Giannini, 2003 [25]12 (14)13 (9–18)Resection +
subtalar arthroereisis by a bioreabsorbable implant
3.3 (3–5.3)11/14 (79%)none
Westberry, 2003 [52]10 (12)12.7 (9–17.9)Complete removal of the coalition
with removal of the sustentaculum tali
5.1 (1.5–8.7)9/12 (75%)One postoperative
wound infection.
One patient
required subsequent lateral column lengthening
Fleming, 2004 [53]12 (14)(11–14)Resection + fat interposition0.5–2100%none
Kernbach, 2008 [26]3 (6)14 (12–17)Resection + flatfoot reconstruction*3.3 (1.3–4.5)6/6 (100%)none
Sperl, 2010 [8]3 (3)13.4 (10–15)Resection + deepithelialized skin flap interposition.3.3 (0.5–8)3/3 (100%)none
Lisella, 2011 [54]7 (8)15 (12–18)Resection + reconstruction3 (2–5)8/8 (100%)1 infection
1 deep vein thrombosis
Mosca, 2012 [13]8 (13)13 (10–18)a) 5 patients (9 ft) with RFF and TCC (coalition area > 50%): CLO + Strayer or TAL** + medial plication.
b) 1 patient (2 ft) with RFF and TCC (coalition area > 50%): simultaneous CLO + resection of the middle
facet coalition + Strayer.
c) 2 patients (2 ft) with residual RFF after the resection
of a middle facet tarsal coalition: CLO + TAL + talonavicular arthrodesis (1 ft)
2–15Group 1: 9/9 (100%)
Group 2: 2/2 (100%)
Group 3: 1/2 (50%)
Group 1: 1 patient developed pain
under the fourth and fifth metatarsal heads on both feet.
Grouo 2: None.
Group 3: 1 patient underwent talonavicular arthrodesis for symptomatic arthritis
Gantsoudes, 2012 [29]32 (49)13TCC resection + fat graft interposition3.542/49 (84%)11 ft (22%) underwent a total of 12 secondary procedures involving the lower extremity, including 2 revisions (4%).
Khoshbin, 2013 [22]11 (13)12 ± 2.5resection alone (1) or with interposition of fat/wax graft (7), flexor digitorum
Longus (4) or flexor hallucis longus (1)
2.213/13 (100%)none
Jagodzinski, 2013 [55]8 (9)15 (11–20)Arthroscopic resection.1–5.57/9 (78%)1 patient developed scar sensitivity at one of the portal sites.
1 patient had posterior tibial nerve damage.
1 patient (2 ft) required further surgery (fusion)
De Wouters, 2014 [21]6 (7)14 (11–16)Resection using 3D printed cutting guides + fascia lata allograft interposition.1.77/7 (100%)none
Kemppainen, 2014 [56]19 (26)13.5 (9–17)Resection with or without intra-operative assessment through a portable CT scanner2 (0,5–4)19/26 (73%)1 case required further surgery
Krief, 2015 [24]3 (3)10 (8–12)Resection + interposition of a sterile silicone sheet3.3 (1–6.7)3/3 (100%)none
Knörr, 2015 [57]15 (16)11.8 (8–15)Arthroscopic resection2.3 (1–3.7)16/16 (100%)Complex regional pain syndrome in 1 patient.
No recurrences.
Hamel, 2016 [58]80 ft8–17a) resection + fat interposition (31)
b) resection + fat interposition + tarsal osteotomy (26)
c) fusion (20)
d) fusion + tarsal osteotomy (3)
3Group 1 27/31 (87%)
Group 2 20/26 (77%)
Group 3 18/20 (90%)
Group 4 3/3 (100%)
3 cases underwent further surgery
Mahan, 2017 [59]36 (51)13.1 ± 2.6resection2.741/51 (80%)2 patients developed superficial wound infection.
Masquijo, 2017 [60]13 (14)14 (11–16)7 patients (8 ft): simultaneous TCC resection of the coalition and reconstruction;
6 patients (6 ft): isolated reconstruction
3.7.14/14 (100%)1: Hardware prominence;
1: superficial infection
Hubert, 2018 [23]10 (12)12.2 (10–18)TCC resection and interposition of pediculated flap of the tibialis posterior tendon sheath4.812/12 (100%)none
Shirley, 2018 [61]16 (16)11.4Conservative treatment.1.7 (0.2–7.4)9/14 (54%)38% of cases required surgery
Present Study55 (81)11.8 (9–17)Group 1: non operative treatment (47); group 2: coalition resection, graft interposition and subtalar arthroereisis (34)6.6 (3–12)26/47 (55%)
26/34 (76%)
No complications, but 6 patients (7) in group 1 were unsatisfied and required surgery