MCQs – Peds Foot 3

Modern Study Review (AI-Generated)

High-Yield Summary

Tarsal coalitions and congenital vertical talus are high-yield topics frequently tested in orthopaedic board exams, focusing heavily on clinical presentation, imaging findings, and surgical indications. The critical clinical decision often hinges on the presence or absence of degenerative changes when considering surgery for tarsal coalitions. While the classic exam answer favors excision for symptomatic coalitions without arthritis, modern practice increasingly emphasizes early diagnosis and tailored surgical timing to optimize joint preservation. For congenital vertical talus, recognizing the characteristic foot position—hindfoot equinovalgus with forefoot dorsiflexion and abduction—is essential for differentiation from other pediatric foot deformities.

High-Yield Decision Matrix

Active Recall Q&A

Congenital Vertical Talus

Q: What is the foot position in congenital vertical talus?
A: Hindfoot equinovalgus with forefoot dorsiflexion and abduction/valgus.
Related Pearl: The hindfoot equinovalgus deformity in congenital vertical talus contrasts with clubfoot, which typically shows hindfoot varus.

Talonavicular Coalition

Q: What is the recommended treatment for a 16-year-old with symptomatic talonavicular coalition and degenerative changes?
A: Triple arthrodesis is the preferred surgical option.
Related Pearl: Triple arthrodesis stabilizes the hindfoot by fusing the talocalcaneal, talonavicular, and calcaneocuboid joints, addressing pain from coalition-related arthritis.

Tarsal Coalition

Q: How does the type of tarsal coalition affect prognosis after excision?
A: Prognosis is better if the coalition bar is fibrous or cartilaginous rather than bony.
Related Pearl: Fibrous or cartilaginous coalitions allow easier resection and better restoration of joint motion compared to osseous bars.

Q: What are the two most common types of tarsal coalition?
A: Calcaneonavicular and talocalcaneal coalitions.
Related Pearl: These coalitions often present in adolescence with pain and limited subtalar motion.

Q: What is the initial treatment approach for tarsal coalition?
A: Symptomatic control with bracing and NSAIDs.
Related Pearl: Conservative management aims to reduce inflammation and mechanical stress before considering surgery.

Q: When is excision indicated in tarsal coalition management?
A: Excision is indicated if symptoms persist despite conservative treatment and no degenerative changes are present.
Related Pearl: Early excision before arthritis develops can preserve joint function and delay or prevent fusion procedures.

Classic Clinical Notes

• The position of the foot in congenital vertical talus – hindfoot equinovalgus, forefoot dorsiflexion and abduction/valgus.

• A 16 year old with symptomatic talonavicular coalition with degenerative changes should probably undergo triple arthrodesis.

• The prognosis for tarsal coalition excision is better if the bar is fibrous or cartilaginous rather than bone. The most common types are calcaneonavicular and talocalcaneal.

• Initial treatment of a coalition is symptomatic control – bracing, NSAIDs, etc.; failing this, excise if no degenerative changes exist.

Last Updated on January 25, 2026 by Christian Veillette