Tarsal Coalition Flashcards
What are tarsal coalitions
Relatively rare anomaly
Presents with varying degrees of fusion and/or restricted movement between two or more tarsal bones
A union between two bones of the tarsus via a bar or bridge
Describe the types of tarsal unions
Osseous (synostosis)
Cartilaginous (synchondrosis)
Fibrous (syndesmosis)
What are the two locations tarsal coalitions may exist
Intra-articular
Extra-articular
What are the different tarsal coalition classifications
Congenital or acquired
Complete or incomplete
Intra-articular or extra-articular (Buckholtz)
Symptomatic or asymptomatic
Anatomic location (Downey)
According to Downey’s Classification, what is Juvenile Type I
Extra-articular coalition
According to Downey’s Classification, what is Juvenile Type II
Intra-articular coalition
In Downey’s classification, what is type A vs B
A - no secondary arthritis
B - secondary arthritis
What is the treatment for Juvenile IA coalition
Resection with interposition of EDB muscle, adipose, implant
What is the treatment for Juvenile IB coalition
Resection with interposition of EDB muscle, adipose, implant
Triple arthrodesis (failed resection)
What is the treatment for Juvenile IIA
Resection with interpositional arthroeresis
Isolated single arthrodesis
Triple arthrodesis
Treatment for Juvenile IIB
Triple arthrodesis after skeletal maturity
Describe the intra-articular location of the a coalition
May be present between two osseous segments that fuse within an anatomical joint with destruction of the existing joint
Is TC coalition intra-articular or extra-articular
Intra-articular
Describe the location of extra-articular coalition
A bar or bridge that fuse so tarsal bones outside an anatomical joint
Is CN bar intra-articular or extra-articulr
Extra-articular
What are the two categories of coalition etiologies
Congenital
Acquired
What are the types of acquired coalitions
Traumatic
Metabolic
Infectious
Neoplastic
What is the most common cause of tarsal coalitions
Traumatic
What are two most common types of tarsal coalitions
Talocalcaneal & calcaneonavicular
- talocalcaneal most common asymptomatic
- calcaneonavicular most common symptomatic
What radiographic view is used for talocalcaneal coalitions
Harris Beath Study
Symptomatic talo-calcaneal coalitions tend to be _______ or _____ facet
Middle or anterior facet
What is the 3rd most common tarsal coalition after talocalcaneal and calcaneonavicular
Talonavicular
What are some associated disorders with coalition
Symphalangism = ankylosis of phalangeal joints
34% of clubfoot patients have tarsal coalitions
Peroneal spastic flatfoot especially calcaneo-navicular
Tibialis spastic varus feet
Tibial dysplasia
Lower bone densities than normal patients
What is the age range for TN coalition pain
3-5 years
What is the age range for CN coalition pain
8-12 years
What is the age range for TC coalition pain
12-16 years
What are different images for coalitions
Harris & Beath
Isherwood
Conway & Cowell
Goldman
Resnick
Smith & Staple
Jay
What is the computed tomography study of choice for coalitions
Smith &’ Staple
Smith & Staple: _____ plane for STJ coalitions
Coronal
Smith & Staple: _____ plane for TN & CC coalitions
Transverse
What is the MRI study of choice for coalitions
Jay
What radiographic signs are seen on TC coalitions
Anterior superior TN joint beaking
Halo effect of talocalcaneal articulation
Flattening & broadening of lateral talar process
Loss of STJ clarity via loss of middle and posterior STJs
Ball and socket ankle joint
What radiographic sings are seen on calcaneal-navicular collation
Anteater sign
Comma sign
What are the conservative treatments for coalitions
Orthotics
BK cast
NSAIDs
Intra-articular steroid injections
PT
What are the surgical treatments for C-N Bar
Badgley bar resection
What are the surgical treatments for T-C coalitions
Triple arthrodesis
Middle facet bridge resection
Fat pad tarsi arthroeresis
STJ fusion interposition
Resection with sinus
Grice-Green extra articular arthrodesis
Resection with extra-articular arthrodesis
