Criteria for surgical decision-making in talocalcaneal tarsal coalitions.

Assessment and management of talocalcaneal middle facet tarsal coalitions present a complex orthopaedic challenge. Various studies have attempted to establish guidelines for surgical intervention based on coalition size and hindfoot alignment. Our paper reviews the historical focus on coalition size, suggesting instead that posterior facet health is a more appropriate consideration for surgical decision making. Additionally, we challenge the traditional method for evaluating hindfoot alignment and propose a more accurate evaluation method. This critical review intends to highlight flaws in historical literature, aiming to trigger a reevaluation of the criteria for surgical intervention in talocalcaneal tarsal coalitions and promote future research studies driven by data and scientifically validated methodologies. Key Concepts: (1)This paper challenges conventional criteria for surgical decision-making in talocalcaneal tarsal coalitions.(2)The authors advocate for a shift in focus, proposing that posterior facet health, rather than coalition size, should be the determinant for resection.(3)Wilde's method for evaluating hindfoot alignment is challenged as being subjective and susceptible to influence by the height/vertical length of the calcaneus visible on individual coronal CT scan slices.(4)The authors propose a more precise assessment of hindfoot alignment using the anatomic axis of the calcaneus, acknowledging the need for further validation.(5)Establishing scientifically tested criteria for posterior facet health/thickness and hindfoot valgus deformity through research will improve consistency in surgical decision making and, thereby, improve patient outcomes. Level of Evidence: V.