Clinical significance of personalized excision of AALTF in progressive collapse foot deformity: a retrospective cohort study

Shangyi Liu^1,2*Xun Shu^1,2Bin Wang^1,2Huarui Yang^1,2Yi Yang^1,2Tongzhu Bao^1,2Tao Ye^2,3*Kangquan Shou^1,2*

• ¹Yichang Central People's Hospital, Yichang, China
• ²China Three Gorges University, Yichang, China
• ³Yichang Second People's Hospital, Yichang, China

Background: It has been suggested that accessory anterolateral talar facet (AALTF) is likely to produce accessory talar facet impingement (ATFI) , thus giving rise to the sinus tarsi pain in progressive collapse foot deformity (PCFD). However, the appropriate strategy for AALTF is not well documented. The aim of this study is to evaluate the relationship between the ATFI and AALTF in the patients with progressive collapse foot deformity and elucidate the optimal treatment for AALTF. Methods: Seventy patients with progressive collapse foot deformity between March 2014 and October 2024 accepted surgery and were split into two groups: AALTF resection group and traditional group(only the flatfoot procedures procedures were performed). All patients underwent radiographic evaluation, FFI, AOFAS, and FAAM-SS scoring surveys preoperatively and at the time of follow-up within 24 months. Results: The AALTF resection group showed significant improvements in outcome measures compared to the traditional treatment group. The AALTF resection group had higher FFI scores (preoperative mean: 41.2 ± 11.4, postoperative mean: 9.3 ± 10.6) compared to the traditional group (preoperative mean: 42.1 ± 10.7, postoperative mean: 16.6 ± 4.5; p<0.001). The AALTF resection group also demonstrated higher AOFAS scores (preoperative mean: 67.3 ± 14.7, postoperative mean: 92.7 ± 8.6) compared to the traditional group (preoperative mean: 68.2 ± 13.8, postoperative mean: 81.5 ± 9.1; p<0.001). FAAM-SS scores were higher in the AALTF resection group (preoperative mean: 39.6 ± 11.6, postoperative mean: 90.6 ± 11.3) than in the traditional group (preoperative mean: 44.7 ± 12.3, postoperative mean: 80.9 ± 5.1; p<0.001). Ankle joint ROM increased more in the AALTF resection group at final follow-up (preoperative mean: 7.3° ± 2.1° to postoperative mean: 19.6° ± 3.8°) compared to the traditional group (preoperative mean: 8.7° ± 1.6° to postoperative mean: 14.1° ± 2.2°; p<0.001). There were no significant differences in radiological outcomes between the two groups. Conclusions: Addressing AALTF in a symptomatic flatfoot is fundamental. Careful preoperative assessment consisting of traumatic history investigation, deliberate physical examination, and standard radiographic evaluation (especially CT and MRI scan) may aid to determine the favorable strategy for this kind of morbidity.