tarsal coalition

Question 1

Hallmark symptom of tarsal coalition

Answer 1

peroneal spastic flatfoot- spasm occurs in response to immobiliation of STJ

Question 2

gold standard imaging for coalitions

Answer 2

CT

Question 3

fibrous coalition, cartilaginous vs ossoues

Answer 3

syndesmosis; synchondrosis, synosotis

Question 4

Age when symptoms begin for TC coalition

Answer 4

12-15 yrs

Question 5

age when symptoms begin for CN bar

Answer 5

8-12 yrs

Question 6

C sign or halo sign

Answer 6

lateral view; C shaped formed by medial outline of talar dome and inferior outline of sustentaculum tali.

C sign or halo sign has been shown to be most sensitive and specific for STJ coalition

Question 7

Talar beaking sign

Answer 7

flaring of the superior margin of talar head for STJ coalition

Question 8

radiographic sign for rounding of the lateral talar process and flattening c

Answer 8

STJ coalition

Question 9

radiographic sign for shortening of talar neck

Answer 9

STJ coalition, due to dysmorphic sustentaculum tali that may be ovoid shaped rather bricked shape

Question 10

ball in socket of talus in ankle mortise is more rounded for what type of coalition? best seen in which view

Answer 10

AP view; STJ coalition

Question 11

anteater sign

Answer 11

lateral view: elongated anterior process of the calcaneus for CN bar

Question 12

hypoplastic lateral talar head

Answer 12

CN bar

Question 13

age for Symptoms of TN coalition

Answer 13

3-5 yrs

Question 14

most common facet for coalition

Answer 14

middle facet

Question 15

Extra-articular coalitions resection via the following Badgley procedure

-type of incision, structures to identify

Answer 15

a) Ollier (curvilinear) incision beginning over the lateral sinus tarsi and ending medially to the lateral aspect of the talonavicular joint
b) Identify and avoid severing the intermediate dorsal cutaneous nerve which travels medially in this area as well as the sural nerve which travels laterally
c) Resect the bar. Be certain to resect enough of the coalition (at least 1 cm).

d) Identify the extensor digitorum brevis muscle and sever at it’s origin
e) Interpose the EDB muscle belly into the space created between the navicular and calcaneus

Question 16

CN bar is best resected by when

Answer 16

Calcaneonavicular bars are best resected by age 14 in order to prevent secondary changes.

Question 17

Advantages of EDB interposition

Answer 17

CN Interposition of the muscle belly into the defect created by the resection serves as a spacer that will prevent complications such as recurrence of the bar as well as hematoma and seroma.

Question 18

most common tarsal coalition

Answer 18

calcaneonavicular coalition

Question 19

what interpositional material is applied in a CN coalition vs TC coalition

Answer 19

extensor digitorum brevis (calcaneonavicular coalition)

split flexor hallucis longus tendon (talocalcaneal coalition)

interposed fat graft

bone wax