PMC5718307_01
Preoperative macroscopic findings: (a) the photograph of the anterior aspect of the feet with the patient in a standing position showed pes cavus of the left foot (black arrows). (b) The photograph of the posterior aspect of the lower legs with the patient in a standing position showed varus deformity of the left heel. (c and d) The longitudinal arch of the left foot was higher than that of the right foot (black arrow). (e) Spasm of the left anterior tibial muscle was observed (black arrowheads).
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Physical examination revealed that his left foot was in the varus position with spasm of the anterior tibial muscle (Figure 1).
Preoperative radiography findings: (a and b) On weight-bearing lateral radiographs, dorsal talar beaking was not observed and the angles of Gissane were not small in both feet. The longitudinal arch of the left foot was higher than that of the right. Bone sclerosis was observed in the dorsal aspects of both calcaneal necks (black arrowheads). (c and d) Weight-bearing posterior-anterior radiographs showed the left calcaneus in varus and the right in valgus.
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Radiographs and computed tomography (CT) scans revealed the absence of tarsal coalition and the presence of AALTFs in both feet (Figures 2 and 3).
Preoperative CT image findings: (a and b) three-dimensional CT scans revealed the presence of AALTFs in both feet. Tiny sulci at AALTFs and dorsal aspects of the calcaneus were identified (black arrowheads).
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Radiographs and computed tomography (CT) scans revealed the absence of tarsal coalition and the presence of AALTFs in both feet (Figures 2 and 3).
Preoperative MRI findings. Unfortunately, MRI performed at the other hospital did not include a good view of the AALTF. (a and b) MRI on T1-weighted images showed a low signal area indicating bone sclerosis on the radiograph (black arrowheads). (c) MRI using STIR sequences demonstrated abutting bone marrow edema between the talus and calcaneus around the left AALTF (black asterisks).
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Magnetic resonance imaging (MRI) using short TI-inversion recovery (STIR) sequences demonstrated abutting bone marrow edema between the talus and calcaneus around the AALTF (Figure 4).
Intraoperative findings: (a) a continuous articular cartilage (black asterisks) from the posterior facet (black arrows) of the talus to AALTF was observed. The superior border of the articular cartilage of AALTF was identified (black arrowheads). (b) After AALTF resection, no talo-calcaneal impingement with eversion of the calcaneus was noted. Black arrow showed the posterior facet (L: lateral malleolus; T: talus; C: calcaneus).
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AALTF with a 3 cm oblique skin incision along the Langer line. A continuous articular cartilage from the posterior facet of the talus to the AALTF was observed (Figures 5(a) and 6). AALTF resection, no talo-calcaneal impingement with eversion of the calcaneus was noted (Figures 5(b) and 7). After surgery, the foot was immobilized in a short-leg splint in the valgus position.