Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with chronic, activity-related foot pain and recurrent ankle sprains. Symptoms localized to the midfoot/hindfoot, exacerbated by uneven terrain. History of progressive loss of subtalar motion. No history of acute trauma. Pain is poorly localized, often described as a dull ache following prolonged weight-bearing.
Clinical Examination Findings
Physical examination reveals rigid flatfoot deformity. Subtalar joint motion is significantly restricted or absent on passive inversion/eversion. Tenderness noted over the talonavicular or calcaneonavicular joint. Compensatory midfoot hypermobility may be present. Gait analysis demonstrates an antalgic pattern with decreased heel-strike and early heel-rise.
Treatment Protocol
Initial management includes activity modification, non-steroidal anti-inflammatory drugs (NSAIDs), and orthotic intervention with medial longitudinal arch support. If conservative measures fail, consider immobilization in a short-leg walking cast. Surgical consultation for possible resection of the coalition or arthrodesis is indicated for refractory cases.