TALOCALCANEAL COALITION IN PATIENTS WHO HAVE FIBULAR HEMIMELIA OR PROXIMAL FEMORAL FOCAL DEFICIENCY - A COMPARISON OF THE RADIOGRAPHIC AND PATHOLOGICAL FINDINGS

The prevalence of congenital anomalies of the foot was studied in nine ty-nine children (105 limbs) who had fibular hemimelia or proximal fem oral focal deficiency, or both. Twenty-six of these patients had had a Syme amputation at our institution and the specimens were analyzed an atomically; they were found to include fourteen talocalcaneal coalitio ns (54 per cent). The preoperative radiographs of these same patients, however, revealed only four such coalitions (15 per cent). Thirty-sev en of the ninety-nine patients had had a Syme amputation previously at another facility (with subsequent follow-up at our institution), and ten of them (ten feet) had radiographs that were adequate for analysis of congenital anomalies. Forty-two feet that had not yet been amputat ed were also analyzed radiographically. Nine of these fifty-two feet i ncluded in the radiographic analysis had a talocalcaneal coalition, a radiographic prevalence similar to that found on the preoperative radi ographs of the twenty-six patients included in the anatomical analysis . The true prevalence of talocalcaneal coalition remains to be determi ned; however, this can be done only at the time of skeletal maturity. Examination of the twenty-six amputation specimens revealed only one t alocalcaneal coalition in the nine patients who had proximal femoral f ocal deficiency alone, six such coalitions in the eight patients who h ad only fibular hemimelia, and seven coalitions in the nine patients w ho had both proximal femoral focal deficiency and fibular hemimelia. T hese findings should be useful in the evaluation of Che radiographic a natomy of the feet in children who have proximal femoral focal deficie ncy or fibular hemimelia, or both, particularly if limb-lengthening is considered as a treatment option.