ADOLESCENT PERONEAL SPASTIC FLATFOOT IN THE ABSENCE OF AN IDENTIFIABLE CAUSE

Abstract

Introduction: Adolescent peroneal spastic flatfoot (PSF) is often regarded as synonymous with tarsal coalition. Inflammatory arthropathies, infections and tumours may, however, all present in this way, and in a few patients with PSF no definitive pathology may be identified.

We aim of to evaluate the causes of adolescent PSF and to develop an an algorithm for its investigation and the management of those patients in whom no underlying pathology is identified.

Methods: All adolescent patients presenting to the senior author with PSF over a two year period were evaluated first for tarsal coalition by means of clinical examination, plain x-rays and CT scanning. If this proved inconclusive an MRI scan was performed and bloods sent for inflammatory and infective markers. If these too identified no treatable cause the patients were treated with a manipulation under anaesthetic, injection of steroid and local anaesthetic into the subtalar joint and immobilization in a below knee cast for 4 weeks. They then received physiotherapy and a talar neutral orthosis. Follow-up was at 4 weeks post-injection and continued until symptoms resolved.

Results: Five patients were found to have PSF with no identifiable cause. All were male, aged 12–17 at presentation. Four completed the treatment. Mean final follow-up was at 10 months post-procedure. All patients reported relief of pain following the procedure and returned to normal activity. At final follow-up, three were still participating in regular sport. One patient suffered a recurrence of his pain.

Conclusion: Adolescent peroneal spastic flatfoot is often, but not always due to tarsal coalition.

If this and other treatable causes have been excluded, treatment with the regime described may give good symptomatic relief in the short to medium term.