SLR - June 2022 - Samantha Ralstin, DPM
Reference: Zide JR, Shivers C, Adair C, Le T, Kanaan Y, Rathjen K, Jo CH, Riccio AI. The Efficacy of Intra-articular Subtalar Steroid Injection for Symptomatic Talocalcaneal Coalitions: A 30-Year Single Institution Experience. J Pediatr Orthop. 2022 May-Jun 01;42(5):e453-e458Level of Evidence: Level III
Reviewed By: Samantha Ralstin, DPM
Residency Program: John Peter Smith Hospital, Fort Worth, TX
Podiatric Relevance: Tarsal coalitions are present in 1-2 percent of the population, with talocalcaneal coalitions constituting 45 percent of all tarsal coalitions. Painful flatfoot deformities in children are frequently seen in Podiatrist offices, and a symptomatic talocalcaneal coalition can be the cause. Most research has been conducted on the surgical treatments of talocalcaneal coalitions, and there are not many studies about the efficacy of nonoperative treatments. The authors of this study hoped to determine the efficacy of subtalar joint injections and their ability to prevent or delay surgical intervention. It is important for Podiatrists to be aware of various conservative treatments that may help prevent surgery, especially for our pediatric population.
Methods: This was a Level III therapeutic study of retrospective nature, reviewing data over 30 years with a total of 125 feet in 83 patients between the ages of 0-18. Patients enrolled had a radiographically confirmed diagnosis of a talocalcaneal coalition. Patients with underlying neuromuscular or syndromic conditions, history of foot and ankle surgery, or those not managed initially with conservative treatments were excluded. It should be noted that patients with planovalgus deformity were included if they met the inclusion criteria. A review of the medical records was performed, and those who underwent a subtalar joint injection after failure of conservative treatments were compared to those who did not receive an injection as part of the conservative management. Primary outcome was defined as the need for surgical intervention and time from presentation to surgery.
Results: Of the 125 feet identified, 77 (62 percent) were managed without surgical intervention and 48 (38 percent) ultimately went on to surgical intervention after failing nonoperative treatment. A total of 34 feet received a corticosteroid injection into the subtalar joint as part of conservative management, with the majority receiving one injection (25/34). In those patients with talocalcaneal coalition who ultimately underwent surgery, 12 received an injection as part of their conservative management and 36 did not. The average time from initial presentation to surgery was 878 days in the injection group and 211 in the noninjection group.
Conclusions: This study is limited by its retrospective design which solely relied on medical chart review, as well as the small sample size, only 34 feet undergoing the subtalar joint injection. At this facility a large number of patients were treated without surgery (62 percent) though this nonoperative treatment was not standardized and varied between the protocols of various surgeons. Those patients who did undergo injection did have a longer time to surgery as compared to those who did not, but this was not significant. Therefore subtalar joint injections may provide some relief and lead to a delay in surgical intervention, which can be valuable in our pediatric population. However, the study was unable to draw any strong conclusions about avoidance of surgical intervention when part of the conservative treatment included the subtalar joint injection. More studies are needed to assess the benefit of this intervention long-term.