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middle facet fibrous talocacaneal coalition

Posted by Tammy L on 7/03/03 at 10:01 (123499)

Hi, I'm looking for some advice. I have been having foot pain for several years now. For years I was being treated for plantar faciitis. Finally, I was sent for an MRI.

The MRI results were as follows:
Findings: There is evidence of a fibrous talocalcaneal calition involving the middle facel th the calcaneus. No bony fusion is identified. No subjacent bone marrow edema is present. Osseous structures are oterwise within normal limits.
There is abnormal morphology and signal intensisty of the spring ligament, most consistent witha sprain. No other ligamentous or tendon abnormality is demonstrated. Ther is a small to moderate sized joint effusion present.
The achilles tendon is within normal limits. The plantar fascia is also grossly normal. There is a marker over the plantar aspect of the foot, but no underlying signal abnormality is seen.
Impression:1.fibrous taocalcaneal coalition 2. abnormal morphology of the spring ligament, likey represesenting a strain. THis could be related to altered mechanics due ot hte coalition 3. grossly normal plantar fascia

A ct scan showed:
the subtalar joints are maintained, with no evidence of osseous coalition. The articular surfaces demonstrate no evidence of sclerosis or bony hypertrophy, no indirect signs of fibrous union.
Distal tibiofibular syndesmosis is maintained.
No soft tissue abnormalities are identified.
Talonavicular, calcaneocuboid articulations are normal.

I've seen 3 different doctors since these tests. Two of them agree with the tarsal coalition findings (as do I) and are willing to operate. Both warn that the surgery can result in more pain.

The 1st gives me 85% success rate since I am only 32 and not overweight. He also wants to do a release of the baxter's nerve though. I am uncomfortable with this. He says the worst side effect of this in numbness. He says that fibrous coalitions are relatively easy and he does a lot of them, but that mine is in an odd location and he has never done one there before.

The 2nd gives me 50/50 odds and doesn't recommend playing with the nerves. This one says that the location of my coalition isn't all that uncommon, but he keeps mentioning chiselling bone. I explained to him that the 1st dr. didn't think that was necessary since it is fibrous and not bony and then he agreed that the other dr. was probobly right.

Can anyone recommend a 3rd dr. for an opinion in the upstate NY area? Being 32 isn't it odd that it hasn't become bony already and is there a chance that it may become bony still?

I can feel an actual ache where the coalition is. Days that I am on my feet a lot, my whole heel seems to throb.

Thanks for your help.

Re: middle facet fibrous talocacaneal coalition

lara on 7/03/03 at 17:26 (123528)

There's a place on the first page of this message board (the page where the six boards are listed), on the top that has the following listing:

heelspurs.com The Heel Pain Book Doctor Articles Products for Sale Message Boards Journal Articles Search Our Surveys Surgery E.S.W.T. Ask The Foot Doctors Rate Your Doctor Videos

Click on the 'rate your doctor' At the top of the page that appears there is a 'view positive doctor ratings'.

There are several entries for doctors in New York state. I understand upstate New York is anything above Westchester county (go figure), so it's a lot of area - if you want to narrow it down a little more it may help spark someone.

Re: middle facet fibrous talocacaneal coalition

Ed Davis, DPM on 7/04/03 at 11:14 (123573)

Tammy:

It is good to see that a more definitive diagnosis has been arrived at.
I too, am a bit uncomfortable with the first opinion. I am not convinced about the Baxter's nerve issue. Such coalitions are not common so if someone states that they 'do a lot of them' that is only possible if that is perhaps a practitioner with a national reputation who is getting referrals from a large geographic area. If the coalition is indeed fibrous, there is generally no need to 'chisel bone.'
Ed

Re: middle facet fibrous talocacaneal coalition

john K on 7/05/03 at 07:46 (123610)

If you want an opnion from a long time foot pain sufferer don't let these guys cut on your feet unless you are absolutely sure there is no other way. If the surgery goes wrong you may have made a bad problem much worse. You don't want to trade a set of orthotics for a wheelchair.

John King