TARSAL COALITIONS

TARSAL COALITIONS
Congenital bridging of two or more tarsal bones of the foot Failure in segmentation and differentiation of primitive mesenchyme Most commonly causes peroneal spastic flatfoot Incidence in the population is less than 1%

TYPES OF COALITIONS
Synostosis Osseous bridge Synchondrosis Cartilaginous bridge Syndesmosis Fibrous bridge

LOCATION OF COALITIONS
Talocalcaneal ~ 45% of cases Calcaneonavicular ~ 45% of cases Talonavicular <2% of cases Calcaneocuboid <2% of cases

TALOCALCANEAL
Between 12 to 16 years of age Pain in the sinus tarsi with activity Decreased ROM of STJ and MTJ Most commonly the middle facet CT is gold standard HarrisBeath radiograph

Facet will not be well demarcated

HARRIS-BEATH VIEW

TC Coalition

TALOCALCANEAL COALITION - LATERAL

Lateral view
Talonavicular beaking Halo sign

CALCANEONAVICULAR COALITION
Between 8 12 years Pain localized to the area over the coalition Decrease ROM at STJ and MTJ Medial-oblique radiograph

Comma sign

CALCANEONAVICULAR - LATERAL

Lateral view

Anteater sign

TALONAVICULAR
Between 3 to 5 years Most asymptomatic Lateral radiograph

Absence of dorsal portion of cyma line

CALCANEOCUBOID
Usually incidental finding on radiograph Asymptomatic Absence of plantar portion of cyma line

COMPUTED TOMOGRAPHY
Frontal plane scan Contiguous sections Between 2 to 5 mm slices From posterior talocalcaneal facet to the navicular

MRI can be used to confirm non-osseous coalitions

TREATMENT

Conservative
Decrease ROM at joint with Shoe modification, orthotics, bracing and casting NSAIDS

Surgical
Arthroplasty with interposition of muscle, adipose tissue or implant Arthrodesis of single or multiple joints

ARTHROPLASTY VS. ARTHRODESIS

Patients age Intraarticular vs. extraarticular Degenerative arthritic changes

ARTICULAR CLASSIFICATION SYSTEM

Juvenile (Osseous Immaturity) Type I - Extraarticular coalition A - No secondary arthritis B - Secondary arthritis Type II - Intraarticular coalition A - No secondary arthritis B - Secondary arthritis Adult (Osseous Maturity) Type I - Extraarticular coalition A - No secondary arthritis B - Secondary arthritis Type II - Intraarticular coalition A - No secondary arthritis B - Secondary arthritis

ARTICULAR CLASSIFICATION SYSTEM

Type

I - Extraarticular A - Arthroplasty BTriple arthrodesis II - Intraarticular A - Arthroplasty Single arthrodesis Triple arthrodesis BTriple arthrodesis

Type

COMMON PROCEDURES

Badgley bar resection

Resection of calcaneonavicular bar with EDB interposition Resection of calcaneonavicular bar with EDB interposition using Keith needle and medial button fixation.

Cowell Procedure

QUESTIONS?

BIBLIOGRAPHY

Kulik, Stephen A., and Thomas O. Clanton. "Tarsal Coalition." Foot and Ankle International 17.5 (1996): 286-96. Print. Journal Article. McGlamry, E. Dalton., and Alan S. Banks. McGlamry's Comprehensive Textbook of Foot and Ankle Surgery. Philadelphia: Lippincott Williams & Wilkins, 2001. Print. Watkins, Leon. Pocket Podiatrics :. Vol. 3. [Metairie, La]: Watkins Food Center, 2003. Print.