Tarsal coalition


Tarsal coalition 1. General considerations

Failure of differentiation of the primitive mesenchyme 

Resultant lack of joint formation


Incidence

< 1%

AD inheritance 

Bilaterality; 20~60%


Common type

T-C (Talocalcaneal) coalition

C-C (Calcaneonavicular) coalition


Tarsal coalition 2. Clinical presentation

Symptomatic coalitions 

Associated with a traumatic event 

Incidental injury during daily activities 


Symptoms & Signs

Dorsolateral foot pain (sinus tarsi area)

Medial foot pain (over anterior, middle facets of calcaneus) 

Foot fatigue walking on uneven surfaces

Flat foot deformity of variable rigidity

Hindfoot valgus

Loss of normal longitudinal arch 

Peroneal muscle tightness and spasm

No inversion of calcaneus upon single-limb heel raise 


Tarsal coalition 3. Radiographic evaluation

Plain radiography 

Beak of talus (Lateral view)

Traction spur at the dorsum of the talus

2ndary sign of tarsal coalition

Hinge-like motion of navicular upon talus due to subtalar joint rigidity


Anteater nose sign (Lateral oblique view)

CN coalition


C sign (Lateral view)

Medial outline of talar dome 

Inferior outline of sustentaculum tali

Creating an overlapped hyperdense region


Tarsal coalition 3. Radiographic evaluation

Plain radiography 

Lateral view

Narrowing of the posterior subtalar joint 

Rounding of lateral process of talus

Flattening of undersurface of talar neck 


Harris axial view

Irregularity of joint contour

Complete obliteration of subtalar joint 


Tarsal coalition 3. Radiographic evaluation

CT

Diagnostic accuracy

Preoperative planning

Early degenerative change of adjacent surfaces

Limitation 

Fibrous / cartilaginous coalition



Tarsal coalition 3. Radiographic evaluation

MRI

Fibrous / cartilaginous coalition

High signal pattern in subchondral bone around coalition

Abnormal stresses across the coalition

Microfracture and edema

Additional soft tissue disorder 

PTT 


Tarsal coalition 4. Treatment 

Asymptomatic patient 

No treatment


Conservative management 

Medication

Icing

Activity modification

Cast or boot immobilization


Tarsal coalition 4. Treatment 

Surgical treatment

Resection of coalition

Goal

To eliminate painful motion at the coalition site

Potentially increasing hindfoot motion


Arthrodesis

Arthritic change of adjacent joints


Simultaneous correction of concomitant valgus deformities 

Depending on severity

Controversial



Tarsal coalition 4. Treatment 

Resection surgery 

Technically more demanding in TC coalition 



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