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Radiographic Diagnosis of Tarsal Coalition

¹ Both authors: 1A71 School of Medicine, 30 N 1900 E, Salt Lake City, UT 84132-2140.

View larger version (93K): [in a new window]   Fig. 1D. —Lateral radiography of foot used to evaluate subtalar coalition. Lateral radiograph of 55-year-old man with tarsal coalition and equivocal talar beak (arrow) shows that projection from head of talus could be interpreted as either beak or osteophyte. Correct diagnosis was made on basis of dysmorphic sustentaculum tali and positive C sign.

View larger version (130K): [in a new window]   Fig. 1A. —Lateral radiography of foot used to evaluate subtalar coalition. Lateral radiograph of 25-year-old man with subtalar coalition shows talar beak (solid straight arrow) as upwards flaring of anterosuperior aspect of talar head. Note C sign (curved arrows), which is continuous cortical contour extending from medial aspect of talus to sustentaculum tali. Middle subtalar facet is not seen. Note that sustentaculum tali (open arrow) has curved undersurface instead of normal flat contour. Talar neck appears shorter than normal.

View larger version (137K): [in a new window]   Fig. 1B. —Lateral radiography of foot used to evaluate subtalar coalition. Lateral radiograph of 55-year-old man with talonavicular osteoarthritis shows that talar osteophyte (straight arrow) hooks forward over talonavicular joint. Middle subtalar joint (curved arrow) is clearly seen and open. C sign is absent.

View larger version (129K): [in a new window]   Fig. 1C. —Lateral radiography of foot used to evaluate subtalar coalition. Lateral radiograph of 34-year-old woman with normal variant of talar ridge (for comparison with talar beak, A) shows that talar ridge (straight arrow) is located at mid neck of talus, at site of attachment of anterior tibiotalar joint capsule. Note also that middle subtalar facet is open with short gap (curved arrow) between cortical outlines of medial talus and sustentaculum tali (i.e., C sign is absent).

View larger version (131K): [in a new window]   Fig. 2A. —Lateral radiographs used to evaluate calcaneonavicular coalition. Lateral radiograph of 32-year-old woman with calcaneonavicular coalition shows that "anteater" sign is present. Anterior process of calcaneus (between arrows) is enlarged and elongated and has blunt tip like anteater's snout.

View larger version (126K): [in a new window]   Fig. 2B. —Lateral radiographs used to evaluate calcaneonavicular coalition. Lateral radiograph of 18-year-old man with severe flexible flatfoot shows normal anterior process for comparison with A. Because of flatfoot deformity, anterior process of calcaneus overlies neck of talus. Despite alteration of normal anatomic relationships between talus and calcaneus, anterior process of calcaneus forms short triangle with sharp tip (arrow).

View larger version (104K): [in a new window]   Fig. 1E. —Lateral radiography of foot used to evaluate subtalar coalition. Lateral radiograph of 35-year-old man with tarsal coalition without talar beak shows that talus appears normal and C sign is absent (arrow). Correct diagnosis was made on basis of dysmorphic sustentaculum tali and nonvisualization of middle subtalar facet.

View larger version (136K): [in a new window]   Fig. 3A. —Anteroposterior radiograph used to evaluate calcaneonavicular coalition. Anteroposterior radiograph of 25-year-old man with nonbony calcaneonavicular coalition shows that navicular bone is broader in mediolateral dimension than head of talus and its lateral aspect is tapered relative to medial portion. Abnormal articulation (arrows) between calcaneus and navicular bone is clearly visible.

View larger version (118K): [in a new window]   Fig. 3B. —Anteroposterior radiograph used to evaluate calcaneonavicular coalition. Anteroposterior radiograph of 40-year-old woman with flexible flatfoot for comparison with A shows that space is clearly seen between lateral aspect of navicular bone (short arrow) and anterior process of calcaneus (long arrow).

View larger version (122K): [in a new window]   Fig. 4A. —Calcaneonavicular coalition without "anteater" sign in 25-year-old man with painful flatfoot. On lateral radiograph, anterior process of calcaneus is obscured by flatfoot deformity.

View larger version (144K): [in a new window]   Fig. 4B. —Calcaneonavicular coalition without "anteater" sign in 25-year-old man with painful flatfoot. On anteroposterior radiograph, navicular bone is broad in mediolateral dimension, and articulation with anterior process of calcaneus (arrow) is visible and enables diagnosis of calcaneonavicular coalition.

View larger version (121K): [in a new window]   Fig. 5A. —Calcaneonavicular coalition without "anteater" sign in 40-year-old woman. On lateral radiograph, anterior process is obscured by midfoot osteoarthritis.

View larger version (130K): [in a new window]   Fig. 5B. —Calcaneonavicular coalition without "anteater" sign in 40-year-old woman. On anteroposterior radiograph, coalition (arrow) is readily apparent.

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