Advanced Learning Pathway: Pediatrics 2 – Tarsal Coalition, Congenital Vertical Talus, Flexible Flatfoot, Clubfoot

Learning Objectives of this Pathway:

• Describe the indications for resection of a tarsal coalition.
• Describe the outcomes for resected tarsal coalitions and how this informs the consent process.
• Explain appropriate treatment options for congenital vertical talus.
• Differentiate between various flexible and rigid pediatric flatfoot conditions.
• Explain appropriate treatment options for flexible pediatric flatfoot deformities including congenital calcaneovalgus and acquired pediatric flatfoot.
• Describe the principles in management of congenital talipes equinovarus (clubfoot).

Day 1: Tarsal Coalition

Clinical Sessions:
Tarsal Coalitions

JFAS Articles:

• A Review of Tarsal Coalition and Pes Planovalgus: Clinical Examination, Diagnostic Imaging, and Surgical Planning
• Diagnosis and Treatment of Pediatric Flatfoot  (NOTE: covers flexible flatfoot, congenital vertical talus, tarsal coalition, iatrogenic/postraumatic, skewfoot, etc.)
• Functional and Radiological Outcomes After Tarsal Coalition Resections: A Minimum of 5-Year Follow-Up
• Reoperations After Tarsal Coalition Resection: A Population-Based Study
• Subtalar Coalitions: Does the Morphology of the Subtalar Joint Involvement Influence Outcomes After Coalition Excision?
• Calcaneonavicular Coalition Resection with Pes Planovalgus Reconstruction
• Resection Arthroplasty: Treatment for Calcaneonavicular Coalition

Outside Journals and Books:

• Rodriguez N, Choung DJ, Dobbs MB. “Rigid pediatric pes planovalgus: conservative and surgical treatment options Clin Podiatr Med Surg 2010; 27:79-92.
• Furdon, SA, Donlon CR. “Examination of the newborn foot: positional and structural abnormalities.”Advanc Neonatal Care 2002; 2(5):248-258.
• Sankar WN, Weiss J, Skaggs DL. “Orthopaedic conditions in the newborn.”J Am AcadOrthop Surg 2009; 17:112- 122.

Day 2: Pediatric Flatfoot

Surgical Techniques e-Learning:

• Common Foot & Ankle Procedures (online format), Kidner Procedure
• Common Foot & Ankle Procedures (online format), Gastrocnemius Recession Distal
• Rearfoot Reconstruction (online format), Tendon Achilles Lengthening
• Rearfoot Reconstruction (online format), Medial Approach Double Arthrodesis  (NOTE: watch from time stamp 5:46 to 9:02 for medial incision dissection used in STJ middle facet coalition resections.)
• Rearfoot Reconstruction (online format), Medial Calcaneal Displacement Osteotomy
• Rearfoot Reconstruction (online format), Gastrocnemius Recession (proximal)
• Rearfoot Reconstruction (online format), Talonavicular Joint Arthrodesis (NOTE: watch time stamps from 8:55 to 11:03 for landmarks and soft tissue structures of medial incision approach along medial column used in some flatfoot procedures.)

Podcasts:
Arthroeresis: Too Much or Not Enough?  

JFAS Articles:

• Diagnosis and Treatment of Pediatric Flatfoot  (NOTE: covers flexible flatfoot, congenital vertical talus, tarsal coalition, iatrogenic/postraumatic, skewfoot, etc.
• Flexible Juvenile Flatfoot Surgical Correction: A Comparison Bewteen Two Techniques After Ten Years’ Experience
• Symptomatic Juvenile Flatfoot Condition: Surgical Treatment

Outside Journals and Books:

• David, MS., and Weinraub, GM (2020). Calcaneovalgus and Congenital Vertical Talus. In M.L. Butterworth and J.T. Marcoux (1^stEd.),The Pediatric Foot and Ankle: Diagnosis and Management.(Chapter 9). Basel, Switzerland: Springer.
• Mahan KT, Flanigan KP. (2013). Flexible Valgus Deformity. In J.T.Southerland (4^thEd.),McGlamry's Comprehensive Textbook of Foot and Ankle Surgery(Chapter 44). Philadelphia, PA: Lippincott Williams & Wilkins.
• Evan, A. (2008) Flatfoot child treatment. J American Pod Med Assoc98(5):386-393.
• Halabchi et al. (2013) Pediatric flexible flatfeet clinical aspects and algorithimic approaches. Iran J Pediatrics 23(3):254-256.
• Kwon, JY and Myerson, MS. (2010) Management of the flexible flatfoot in the child: a focus on the use of osteotomies for correction.Foot Ankle Clin N America15:309-322.
• Pfieffer, M et al (2006) Prevalence of flatfoot in the preschool aged children.Pediatric.188: 634-639.
• Sullivan, J. (1999) Pediatric flatfoot evaluation and management.J of American AcadOrthop Surg7:44-53.

Day 3: Clubfoot

Podcasts:
Clubfoot

JFAS Articles:
The Natural History and Longitudinal Study of the Surgically Corrected Clubfoot

Outside Journals and Books:

• Staheli, L. Clubfoot Ponseti Management 3^rdEdition. Global HELP Organization, 2009.
• Cicchineli, LD., et al (2013). Clubfoot. In J.T. Southerland (4^thEd.),McGlamry's Comprehensive Textbook of Foot and Ankle Surgery(Chapter 74). Philadelphia, PA: Lippincott Williams & Wilkins.
• Hatch, DJ (2020). Congenital Talipes Equinovarus. In M.L. Butterworth and J.T. Marcoux (1^stEd.),The Pediatric Foot and Ankle: Diagnosis and Management.(Chapter 12). Basel, Switzerland: Springer.
• Cummings RJ, et al. “Congenital clubfoot.”AAOS InstrucCoursLect2002; 51:385-400.
• Coplan J and Herzenberg J (2010). Non-Operative Treatment of Congenital Clubfoot. InDrennan’s The Child’s Foot & Ankle (2nd Ed.) McCarthy and Drennan editors, Lippincott Williams & Wilkins: p.64-74.-74.
• Dobbs MB, et al. “Treatment of idiopathic clubfoot: an historical review.”Iowa Orthop J 2000; 20:50-64.
• Dobbs M, et al. Factors Predictive of Outcome After Use of the Ponseti Method for the Treatment of Idiopathic Clubfeet. JBJS, Jan 2004; 86-A (1): 22-27.
• McCauley JC. “Clubfoot: history of the development and the concepts of pathogenesis and treatment.”Clin Orthop Rel Res 1966: 51-63.
• Morcuende J, et al. Radical Reduction in the Rate of Extensive Corrective Surgery for Clubfoot Using the Ponseti Method. Pediatrics, Feb 2004; 113(2): 376-380.
• Parker SE, et al. “Multistate study of the epidemiology of clubfoot.”Birth Defects Res Part A: Clin Mol Terat2009; 85:897-904.
• Ponsetti, Igancio V. Congenital clubfoot: Fundamentals of treatment (1996) Oxford University Press Inc., New York, N.Y.
• Radler C, et al. Radiographic Evaluation of Idiopathic Clubfeet Undergoing Ponseti Treatment, JBJS, June 2007; 89-A (6): 1177-1183.
• Roye DP, Roye BD. “Idiopathic congenital talipes equinovarus.”J Am AcadOrthop Surg 2002; 10:239-248.
• Thompson , et al. Surgical management of resistant congenital talipes equinovarus deformities, JBJS, 1982; 64-A: 652-665.
• Turco, Vincent J. Clubfoot (1981) Churchill Livingstone Inc., New York, N.Y.