Interposition of the split flexor hallucis longus tendon after resection of a coalition of the middle facet of the talocalcaneal joint

Ten consecutive patients (fourteen feet) who had a painful coalition of the middle facet of the talocalcaneal joint with restricted motion of that joi nt were managed with a resection of the coalition and interposition of a sp lit flexor hallucis longus tendon in 1992, 1993, or 1994. Initial nonoperat ive treatment of all of the feet had failed. According to the ankle-hindfoo t clinical rating system of the American Orthopaedic Foot and Ankle Society , there were eleven excellent results and one good, one fair,and one poor r esult at a mean of fifty-one months (range, thirty-two to sixty months) aft er the procedure. Thirteen of the fourteen procedures resulted in considera ble relief of pain, an improved range of motion of the talocalcaneal joint, and improved function of the foot. No patient had symptoms or functional i mpairment of the great toe secondary to the interposition of the split flex or hallucis longus tendon. On the basis of these early;results, tendon inte rposition appears to be an excellent procedure for the treatment of a sympt omatic coalition of the middle facet of the talocalcaneal joint after initi al nonoperative treatment has failed. The presence of degenerative osteoart hritis in the other facets of the talocalcaneal joint is a contraindication to this procedure. The long-term results have yet to be determined. Howeve r, the standardized rating system used in the present study will allow accu rate comparison of our results with those of subsequent studies.