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 CALCANEONAVICULAR BONY BAR CALCANEONAVICULAR ( OTHER THAN BONY ELEMENT ) TALOCALCANEAL AT MID FACET BILATERAL 50 % MALES MORE COMMON LEAST COMMON - CALCANEOCUBOID, TALOCUBOID

NO SECONDARY ARTHRITIS NO SECONDARY ARTHRITIS CLASSIFICATION 1 ANATOMIC 2 FUSION ELEMENT 3 ARTICULAR JUVENILE ADULT CARTILAGE INTRAARTICULAR OSSEOUS IMMATURITY OSSEOUS MATURITY TALOCALCANEAL FIBROUS MIDDLE BONY POSTERIOR ANTERIOR TYPE 1 EXTRAARTICULAR COMBINED COMBINATION 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 FIBULA MEDIAL CUNEIFORM LATERAL CUNEIFORM

X-RAY VIEWS X- RAY 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

CALCANEONAVICULAR COALITION MOST COMMON EASY TO DIAGNOSE OSSIFIES BY AGE OF 8 - 12 yrs 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 PRIMARY SIGNS OSSEOUS COALITION BONY BAR / BRIDGE NONOSSEOUS COALITION PROXIMITY ARTICULAR SURFACES IRREGULAR DEGENERATIVE CHANGES

REVERSE ANTEATER NOSE SIGN

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

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

RIDGE BEAK OSTEOPHYTE

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

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

OSSEOUS COALITION NONOSSEOUS COALITON SUBTLE CHANGES 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

CALCANEONAVICULAR COALITION IN LEFT FOOT

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

CUBONAVICULAR COALITION OBLIQUE RADIOGRAPH CORONAL CT

OSSEOUS CARTILAGINOUS FIBROUS CALCANEONAVICULAR TALOCALCANEAL CRITERIA SUSPECTED BONES 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 CRITERIA 3.OTHERS : TALAR BEAK, MARROW EDEMA , FRACTURE SIGN - DRUNKEN WAITER SIGN 2.OTHERS : TALAR BEAK, MARROW EDEMA , FRACTURE

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

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