Tarsal coalition
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| Calcaneonavicular tarsal coalition. (Image courtesy of RadsWiki) |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
- Tarsal coalition represents abnormal fusion between two or more tarsal bones and is a frequent cause of foot and ankle pain.
- Calcaneonavicular and talocalcaneal coalitions are encountered most frequently; fusion at other sites is much less common. [1]
- Tarsal coalitions may be:
- Osseous
- Cartilaginous
- Fibrous
- Initially, all patients with tarsal coalition are treated conservatively with orthotics, casting, nonsteroidal anti-inflammatory medications, steroid injections, or physical therapy.
- Many patients fail conservative therapy and are then treated operatively.
- Calcaneonavicular coalitions may be treated with resection.
- Talocalcaneal coalitions are treated surgically with resection of the middle facet bony bridge, often with fat interposition.
Diagnostic Findings for Tarsal coalition
Radiographs
- Use of conventional radiography alone is often sufficient to diagnose most calcaneonavicular and talonavicular coalitions
- Calcaneonavicular coalitions are best depicted on 45° internal oblique radiographs.
- The calcaneus and navicular do not normally articulate. With osseous coalition, a bony bar that bridges the two bones is seen.
- With fibrous or cartilaginous coalition, the bones are in close proximity, both have irregular surfaces, and the anteromedial calcaneus is abnormally widened or flattened.
- On lateral radiographs, elongation of the anterior dorsal calcaneus may simulate an anteater's nose.
- Hypoplasia of the talus may also be observed with calcaneonavicular coalition.
Talocalcaneal Coalition
- The subtalar joint consists of the anterior, middle, and posterior facets.
- Talocalcaneal fusion most commonly involves the middle facet at the level of the sustentaculum tali.
- Talocalcaneal coalitions may be difficult to visualize on the three standard radiographic views of the foot because of the complex orientation of the subtalar joint.
- A number of secondary radiographic signs of talocalcaneal coalition have been described, including a talar beak, narrowing of the posterior subtalar joint, rounding of the lateral talar process, and lack of depiction of the middle facets on lateral radiographs
- A talar beak occurs because of impaired subtalar joint motion, which results in the navicular overriding the talus.
- Another radiographic finding seen on lateral views in talocalcaneal coalition is the C sign.
- A C-shaped line outlines the medial talar dome and posteroinferior sustentaculum.
- The C sign results from bone bridging between the talar dome and sustentaculum, as well as the prominent inferior outline of the sustentaculum.
- The C sign may be observed in both osseous and nonosseous coalitions. Variations in sustentacular size and orientation may affect the reliability of this sign.
Clinical Findings
References
- ↑ Joel S. Newman, and Arthur H. Newberg. Congenital Tarsal Coalition: Multimodality Evaluation with Emphasis on CT and MR Imaging. RadioGraphics 2000 20: 321-332.
See Also
External Links
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