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IMAGING IN TARSAL COALITION DR.PREM CHAND PALADUGU AARUPADAI VEEDU MEDICAL COLLEGE & HOSPITAL.

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Presentation on theme: "IMAGING IN TARSAL COALITION DR.PREM CHAND PALADUGU AARUPADAI VEEDU MEDICAL COLLEGE & HOSPITAL."— Presentation transcript:

1 IMAGING IN TARSAL COALITION DR.PREM CHAND PALADUGU AARUPADAI VEEDU MEDICAL COLLEGE & HOSPITAL

2 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 LEAST COMMON - CALCANEOCUBOID, TALOCUBOID

3 TALOCALCANEAL MIDDLE POSTERIOR EXTRAARTICULAR INTRAARTICULAR 1 ANATOMIC CLASSIFICATION OSSEOUS IMMATURITY ADULTJUVENILE TRIGONAL CUBOIDONAVICULAR CALCANEONAVICULAR NAVICULOCUNEIFORM CALCANEOCUBOID TALONAVICULAR ANTERIOR COMBINATION COMBINED BONY TYPE 2 INTRAARTICULAR SECONDARY ARTHRITIS NO SECONDARY ARTHRITIS CARTILAGE FIBROUS TYPE 1 EXTRAARTICULAR OSSEOUS MATURITY SECONDARY ARTHRITIS NO SECONDARY ARTHRITIS 2 FUSION ELEMENT 3 ARTICULAR

4 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 yrs TC COALITION yrs

5 MEDIAL CUNEIFORM LATERAL CUNEIFORM FIBULA TIBIA

6

7 X-RAY VIEWS ANTEROPOSTERIOR VIEW - NON WEIGHT BEARING LATERAL INTERNAL OBLIQUE 45 * ( ANGULATION SHOULD BE TAILORED TO THE PATIENT ) HARRIS BEATH / AXIAL VIEW CALCANEONAVICULAR COALITION - EASY TO DETECT ON X- RAY TALOCALCANEAL COALITION - IF NOT VISUALIZED ON X RAY USE CT X- RAY

8 PRIMARY SIGNS OSSEOUS COALITION BONY BAR / BRIDGE NONOSSEOUS COALITION PROXIMITY ARTICULAR SURFACES IRREGULAR DEGENERATIVE CHANGES SECONDARY SIGNS ANTEATER NOSE 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 CALCANEONAVICULAR COALITION MOST COMMON EASY TO DIAGNOSE OSSIFIES BY AGE OF yrs

9 ANTEATER NOSE SIGN REVERSE ANTEATER NOSE SIGN

10 TALOCALCANEAL COALITION TALAR BEAK C SIGN BROADENING OF LATERAL PROCESS OF TALUS ABSENT MIDDLE FACET NARROWING OF POSTERIOR SUBTALAR JOINT

11 TALOCALCANEAL COALITION LATERAL RADIOGRAPH OF LEFT FOOT LATERAL RADIOGRAPH OF RIGHT FOOT

12 RIDGE BEAK OSTEOPHYTE

13 LATERAL RADIOGRAPH OF RIGHT FOOT AP RADIOGRAPH OF RIGHT FOOT WITH NAVICULAR LIMITED TO INFERIOR JOINT SPACE NON OSSEOUS COALITION OF MEDIAL CUNEIFORM

14 CT BOTH FEET IMAGED SIMULTANEOUSLY AXIAL CORONAL ( PERPENDICULAR TO SUBTALAR JOINT ) SAG - OPTIONAL MINIMAL 3 mm CUTS ANKLE MRI PULSE SEQUENCES AXIAL : PD FSE WITH FAT SATURATION; FSE T2 WITH FAT SATURATION SAGITTAL : T 1 SE, STIR CORONAL : T2 FSE MRI TECHNICAL PARAMETERS

15 AXIAL MPRCORONAL MPR SAG MPR CORONAL MPR SAG MPR ARTICULAR FACETS OF SUBTALAR JOINT

16 OSSEOUS COALITION BONY BAR AT MIDDLE FACET VARIABLE INVOLVEMENT - ANTERIOR, POSTERIOR FACETS 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

17 CALCANEONAVICULAR COALITION IN LEFT FOOT

18 TALOCALCANEAL COALITION B/L OSSEOUS TC COALITION B/L NONOSSEOUS TC COALITION

19 CUBONAVICULAR COALITION CORONAL CT OBLIQUE RADIOGRAPH

20 OSSEOUS CARTILAGINOU S FIBROUS CALCANEONAV ICULAR TALOCALCANE AL PRIMARY CRITERIA CONTINUITY OF MARROW SPACE BETWEEN SUSPECTED BONES LOSS OF JOINT SPACE WITH SIGNAL INTENSITY OF CARTILAGE OR FLUID BETWEEN SUSPECTED BONES AREAS OF INTERMEDIATE OR LOW SIGNAL INTENSITY BRIDGING THE SUSPECTED BONES LOSS OF MARROW FAT BETWEEN CALCANEUS AND NAVICULAR LOSS OF MARROW FAT BETWEEN TALUS AND CALCANEUS SECONDARY CRITERIA 1.BLUNTED ANTERIOR CALCANEAL PROCESS 2.SIGNS: ANTEATER, REVERSE ANTEATER 3.OTHERS : TALAR BEAK, MARROW EDEMA, FRACTURE 1.SIGN - DRUNKEN WAITER SIGN 2.OTHERS : TALAR BEAK, MARROW EDEMA, FRACTURE

21 OSSEOUS SUBTALAR COALITION WITH CONTNOUS MARROW SPACE SAG T 1 WEIGHTED MR OSSEOUS SUBTALAR COALITION BLUNTING OF ANTERIOR CALCANEAL PROCESS SUBCHONDRAL BONE MARROW EDEMA FIBROUS CALCANEONAVICULAR COALITION SAG STIR MRI CARTILAGINOUS COALITION FLUID LIKE SIGNAL AT CALCANEONAVICULAR COALITION SAG STIR MRI BLUNTED ANTERIOR CALCANEAL PROCESS POSTERIOR ELONGATION OF NAVICULAR CALCANEONAVICULAR COALITION SAG T1 WEIGHTED MRI TALAR BEAK

22 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

23 CONCLUSION IMAGING PLAYS A CRUCIAL ROLE IN EARLY DIAGNOSIS OF TARSAL COALITION AND HELPS IN GUIDING MANAGEMENT

24 REFERENCES CONGENITAL TARSAL COALITION : MULTIMODALITY EVALUATION WITH EMPHASIS ON CT AND MRI IMAGING ; RADIOGRAPHICS 2000; 20: THE ANTEATER NOSE SIGN ; RADIOLOGY 2007; 245:


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