The management of painful rigid flatfoot (RFF) with talocalcaneal coalition (TCC) is controversial. We aimed to compare operative and nonoperative treatment in children with RFF and TCC. We retrospectively reviewed medical records and radiographs of children with RFF and TTC treated between 2005 and 2015. The nonoperative treatment consisted of manipulation under anesthesia, cast immobilization and shoe insert after cast removal. The operative treatment consisted of combined TCC resection, graft interposition and subtalar arthroereisis. Thirty-four children (47 ft) in the nonoperative group and twenty-one children (34 ft) in the operative group were included. No differences were found between groups, concerning baseline characteristics. The mean age at treatment was 11.8 years (9–17): 11.6 (9–17) for the nonoperative group, 12.2 (10–15) for the operative group. The mean follow-up averaged 6.6 (3–12) years and was significantly longer in the nonoperative group (7.8 versus 4.7 years; p < 0.0005), since the operative procedure was increasingly practiced in the latest years. There were no complications in either groups, but 6 patients (7 ft) in the nonoperative group were unsatisfied and required surgery. At the latest follow-up, the AOFAS-AHS improved in both groups, although the operative group showed significantly better improvement. The operative group reported also significantly better FADI score, after adjustment for follow-up and baseline variables. The operative treatment showed better results compared to the nonoperative treatment. Symptomatic RFF with TCC in children can be effectively treated in one step with resection, graft interposition and subtalar arthroereisis. Further prospective randomized studies are needed to confirm our findings and to identify the best operative strategy in this condition.

中文翻译：

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僵硬的扁平足和足突联合患儿的手术治疗与非手术治疗

掌local联合（TCC）治疗疼痛性僵硬的扁平足（RFF）是有争议的。我们旨在比较RFF和TCC儿童的手术和非手术治疗。我们回顾性研究了2005年至2015年间接受治疗的RFF和TTC儿童的病历和X线照片。非手术治疗包括麻醉下操作，固定石膏和去除石膏后插入鞋。手术治疗包括联合TCC切除，移植物介入和距下动脉硬化。非手术组中有34名儿童（47英尺），手术组中有21名儿童（34英尺）。两组之间在基线特征方面没有发现差异。治疗的平均年龄为11.8岁（9-17）：非手术组为11.6（9-17），为12岁。手术组2（10–15）。平均随访时间平均为6.6（3-12）年，非手术组的平均随访时间明显更长（7.8年与4.7年； p <0.0005），因为最近几年越来越多地采用手术方法。两组均无并发症，但非手术组中有6例（7英尺）患者不满意，需要手术治疗。在最新的随访中，两组的AOFAS-AHS均得到改善，尽管手术组表现出明显改善。手术组报告，在对随访和基线变量进行调整后，FADI评分也明显提高。与非手术治疗相比，手术治疗显示出更好的效果。患儿TCC的有症状RFF可以通过一步切除而得到有效治疗，移植物介入和距下动脉硬化。需要进一步的前瞻性随机研究以证实我们的发现并确定这种情况下的最佳手术策略。