Learning objectives
To improve knowledge of the different types of tarsal coalition and their imaging findings.
To gain an understanding of how these patients present clinically and when to suspect the diagnosis.
To have a clearer insight into the imaging management of these patients and the strengths and weaknesses for the various coalitionswith differentimaging modalities.
Background
Congenital tarsal coalition is an abnormal union between two or more tarsal bones. Coalitions may be osseous,
cartilaginous or fibrous.
The morphological subclassification of coalitions is really a contiuum begining as cartilaginous,
progressing to fibrous and finally ossifying and these subtypes may coexist.
Calcaneonavicular and talocalcaneal are the most common types of coalition accounting for 90% of all tarsal coalitions.
Other sites such as talonavicular and calcaneocuboid are encountered much less frequently.
The overall prevalence is estimated to be 1-2%.
An autosomal dominant pattern of...
Imaging findings OR Procedure details
In the next section the imaging managemnt of these pateints is reviewed together with many examples of the various types of coalitions using multiple image modalities.
The following three images are from the same patient showing different views of an osseous calcaneonavicular coalition with a fracture through it:
The following three images are from the same patient who had an arthrogram following previous inconclusive investigations:
Other combinations of coalitions such as talonavicular or calcaneocuboid are very rare.
The following two images are from the same...
Conclusion
Congenital tarsal coalition is an important cause of foot and ankle pain in young patients. Diagnosis can often be made with conventional radiography,
even when the diagnosis is not clinically suspected. The importance of early diagnosis is in guiding definitive imaging,
which assists in early management decisions.
Where conservative management has failed,
surgical intervention is indicated and this may have a more favourable outcome if performed before ossification of the coalition occurs.
Personal Information
Dr.
Jalpesh Jethwa,
Specialist Registrar in Radiology.
Dr.
Martin Tapp,
Consultant Radiologist.
Radiology Department,
Torbay Hospital,
South Devon Healthcare NHS Trust,
Torquay,
Devon,
TQ2 7AA,
England.
References
Joel S.
Newman,
MD and Arthur H.
Newberg,
MD
Congenital Tarsal Coalition: Multimodality Evaluation with Emphasis on CT and MR Imaging
March 2000 RadioGraphics,
20,321-332.
Julia Crim,
Radiologic Clinics of North America
Imaging of Tarsal Coalition
Volume 46,
Issue 6,
Pages 1017-1026
Pediatric Orthopedic Radiology - (1992) by M.
B.
Ozonoff
pages 391,
440-460
http://emedicine.medscape.com/article/396694-overview
http://emedicine.medscape.com/article/1233780-overview
http://radiopaedia.org/articles/tarsal_coalition
http://www.radswiki.net/main/index.php?title=Tarsal_coalition
Wheeless' Textbook of Orthopaedics,
ebook @ www.wheelessonline.com/ortho/tarsal_coaliltion
With special thanks to Dr Philip White,
Consultant Radiologist Torbay Hospital and Dr Richard Seymour,
Consultant Radiologist Torbay Hospital for...