IMAGING IN TARSAL
COALITION
DR.PREM CHAND PALADUGU
AARUPADAI VEEDU MEDICAL COLLEGE & HOSPITAL
•
TARSAL BONES COMPRISE THE BONES OF MID & HIND FOOT WHICH ARE SEVEN IN
NUMBER
•
COALITION MEANS FUSION
•
INCIDENCE
•
1-2 %
•
HIND FOOT MC
1. CALCANEONAVICULAR BONY BAR
2. CALCANEONAVICULAR ( OTHER THAN BONY ELEMENT )
3. TALOCALCANEAL AT MID FACET
•
BILATERAL 50 %
•
MALES MORE COMMON
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LEAST COMMON - CALCANEOCUBOID, TALOCUBOID
CLASSIFICATION
1 ANATOMIC
INTRAARTICULAR
TALOCALCANEAL
MIDDLE
POSTERIOR
2 FUSION ELEMENT
CARTILAGE
JUVENILE
FIBROUS
OSSEOUS
IMMATURITY
ARTICULAR
ADULT
OSSEOUS
MATURITY
BONY
ANTERIOR
COMBINATION
3
TYPE 1 EXTRAARTICULAR
COMBINED
NO SECONDARY ARTHRITIS
TALONAVICULAR
SECONDARY ARTHRITIS
CALCANEOCUBOID
TYPE 2 INTRAARTICULAR
NAVICULOCUNEIFORM
NO SECONDARY ARTHRITIS
EXTRAARTICULAR
SECONDARY ARTHRITIS
CALCANEONAVICULAR
CUBOIDONAVICULAR
TRIGONAL
•
EMBRYOLOGY
•
FAILURE OF DIFFERENTIATION , SEGMENTATION OF PRIMITIVE
MESENCHYME DUE TO GENETIC MUTATION
•
INHERITANCE
•
AUTOSOMAL DOMINANT , VARIABLE PENETRANCE
•
ETIOLOGY
•
CONGENITAL , TRAUMA, INFLAMMATORY, INFECTIOUS
•
CLINICAL FEATURES
•
YOUNG PT WITH PAIN IN FOOT AGGRAVATED BY EXERTION
•
RIGID HIND FOOT
•
EVERTED FOOT
•
TIGHT HEEL CORD
•
LOSS OF SUBTALAR MOTION
•
DECREASED PLANTAR FLEXION
•
PAIN
•
CORRELATES WITH TIMING OF OSSIFICATION OF FIBROUS
COMPONENT
•
CN COALITION 8 -12 yrs
•
TC COALITION 12 - 16 yrs
TIBIA
MEDIAL
CUNEIFORM
LATERAL
CUNEIFORM
FIBULA
X- RAY
X-RAY VIEWS
•
ANTEROPOSTERIOR VIEW - NON WEIGHT BEARING
•
LATERAL
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INTERNAL OBLIQUE 45 * ( ANGULATION SHOULD BE TAILORED
TO THE PATIENT )
•
HARRIS BEATH / AXIAL VIEW
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CALCANEONAVICULAR COALITION - EASY TO DETECT ON XRAY
•
TALOCALCANEAL COALITION - IF NOT VISUALIZED ON X RAY
USE CT
CALCANEONAVICULAR COALITION
MOST COMMON
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EASY TO DIAGNOSE
•
SECONDARY SIGNS
ANTEATER NOSE
OSSIFIES BY AGE OF 8 - 12 yrs
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PRIMARY SIGNS
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OSSEOUS COALITION
BONY BAR / BRIDGE
•
NONOSSEOUS COALITION
PROXIMITY
ARTICULAR SURFACES
IRREGULAR
DEGENERATIVE CHANGES
BONY BAR / ANOMALOUS CONNECTION
BETWEEN ANTERIOR PROCESS OF
CALCANEUS , NAVICULAR
REVERSE ANTEATER NOSE
BROADENING OF NAVICULAR PROCESS
HYPOPLASIA OF TALUS
TALAR BEAK
NON SPECIFIC SIGN; SEEN IN
ABNORMAL SUBTALAR MOTION
ANTEATER NOSE SIGN
REVERSE ANTEATER NOSE SIGN
TALOCALCANEAL
COALITION
•
TALAR BEAK
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C SIGN
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BROADENING OF LATERAL PROCESS OF
TALUS
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ABSENT MIDDLE FACET
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NARROWING OF POSTERIOR SUBTALAR
JOINT
TALOCALCANEAL COALITION
LATERAL RADIOGRAPH
OF RIGHT FOOT
LATERAL RADIOGRAPH
OF LEFT FOOT
RIDGE
BEAK
OSTEOPHYTE
NON OSSEOUS COALITION OF MEDIAL CUNEIFORM
WITH NAVICULAR LIMITED TO INFERIOR JOINT SPACE
AP RADIOGRAPH OF RIGHT FOOT
LATERAL RADIOGRAPH OF RIGHT FOOT
TECHNICAL PARAMETERS
MRI
CT
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BOTH FEET IMAGED
SIMULTANEOUSLY
ANKLE MRI PULSE SEQUENCES
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AXIAL : PD FSE WITH FAT
SATURATION; FSE T2 WITH FAT
SATURATION
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AXIAL
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CORONAL ( PERPENDICULAR
TO SUBTALAR JOINT )
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SAGITTAL : T 1 SE, STIR
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SAG - OPTIONAL
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CORONAL : T2 FSE
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MINIMAL 3 mm CUTS
ARTICULAR FACETS OF SUBTALAR JOINT
AXIAL MPR
SAG MPR
CORONAL MPR
SAG MPR
CORONAL MPR
CORONAL MPR
SAG MPR
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OSSEOUS COALITION
BONY BAR AT MIDDLE FACET
VARIABLE INVOLVEMENT - ANTERIOR , POSTERIOR FACETS
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NONOSSEOUS COALITON
MIDDLE FACET NARROWING
CYSTIC DEGENERATIVE CHANGES
•
SUBTLE CHANGES
MINIMAL NARROWING AT MIDDLE FACET
ALTERED MORPHOLOGY
•
CHANGES IN NORMAL FOOT WITH CONTRALATERAL COALITION
•
ALTERED MORPHOLOGY OF MIDDLE FACET, SUSTENTACULUM TALI
•
SUSTENTACULUM TALI MORPHOLOGY
N - SLOPES UPWARDS
ABNORMAL - SLOPES DOWNWARDS, HORIZONTALLY ORIENTED
DRUNKEN WAITER SIGN
CALCANEONAVICULAR
COALITION IN LEFT FOOT
TALOCALCANEAL COALITION
B/L OSSEOUS TC
COALITION
B/L NONOSSEOUS TC
COALITION
CUBONAVICULAR COALITION
OBLIQUE
RADIOGRAPH
CORONAL
CT
OSSEOUS
PRIMARY
CRITERIA
SECONDARY
CRITERIA
CARTILAGINOU
S
FIBROUS
CALCANEONAV TALOCALCANE
ICULAR
AL
LOSS OF JOINT
AREAS OF
CONTINUITY OF
SPACE WITH
INTERMEDIATE OR LOSS OF MARROW
MARROW SPACE
SIGNAL INTENSITY
LOW SIGNAL
FAT BETWEEN
BETWEEN
OF CARTILAGE OR
INTENSITY
CALCANEUS AND
SUSPECTED BONES FLUID BETWEEN
BRIDGING THE
NAVICULAR
SUSPECTED BONES SUSPECTED BONES
LOSS OF MARROW
FAT BETWEEN
TALUS AND
CALCANEUS
1.BLUNTED
ANTERIOR
CALCANEAL
PROCESS
1. SIGN - DRUNKEN
2.SIGNS:
WAITER SIGN
ANTEATER,
2.OTHERS : TALAR
REVERSE
BEAK, MARROW
ANTEATER
EDEMA , FRACTURE
3.OTHERS : TALAR
BEAK, MARROW
EDEMA , FRACTURE
OSSEOUS SUBTALAR
COALITION
SAG T 1 WEIGHTED MR
FIBROUS
CALCANEONAVICULAR
COALITION
SAG STIR MRI
TALAR BEAK
SUBCHONDRAL BONE MARROW
EDEMA
OSSEOUS SUBTALAR
COALITION WITH
CONTNOUS MARROW SPACE
CARTILAGINOUS
COALITION
SAG STIR MRI
BLUNTING OF
ANTERIOR CALCANEAL
PROCESS
CALCANEONAVICULAR
COALITION
SAG T1 WEIGHTED MRI
FLUID LIKE SIGNAL AT
CALCANEONAVICULAR
COALITION
BLUNTED ANTERIOR CALCANEAL
PROCESS
POSTERIOR ELONGATION
OF NAVICULAR
SAG T1 WEIGHTED MRI
•
DYSPLASTIC
SUSTENTACULUM TALI
OCCURING WITH A
SUBTALAR COALITION HAS
BEEN LIKENED TO A
WAITER HAVING TROUBLE
CARRYING HIS TRAY (
EITHER AN UPTURNED OR
DOWNTURNED HAND AND
PLATE ) WHILE
INTOXICATED
CONCLUSION
•
IMAGING PLAYS A CRUCIAL ROLE IN EARLY
DIAGNOSIS OF TARSAL COALITION AND
HELPS IN GUIDING MANAGEMENT
REFERENCES
•
CONGENITAL TARSAL COALITION :
MULTIMODALITY EVALUATION WITH
EMPHASIS ON CT AND MRI IMAGING ;
RADIOGRAPHICS 2000; 20:321-332
•
THE ANTEATER NOSE SIGN ; RADIOLOGY
2007; 245:604-605