Tarsal Coalitions Flashcards
What is a tarsal coalition?
when a union btwn 2 tarsal bones causes restricted motion or absence of motion
What is a bar?
extra-articular coalition that occurs outside a normal joint
Ex. calcaneonavicular bar
What is a bridge?
intra-articular coalition that occurs at a normal joint site
Ex. talocalcaneal bridge
give some examples of extra-articular coalitions.
Calcaneonavicular
Cubonavicular
give some examples of intra-articular coalitions.
talocalcaneal
talonavicular
calcaneocuboid
naviculocuneiform
Describe the 4 classifications of tarsal coalitions.
- etiology
- anatomic
- tissue type
- articular involvement
what is the most common cause of tarsal coalition in pediatric patients?
congenital etiology
what is the most common cause of tarsal coalition in adult patients?
acquired etiology
Describe Pfitzner’s theory of congenital cause of tarsal coalition.
incorporation of accessory ossicles into the normal tarsal bones
Describe Leboucq’s theory of congenital cause of tarsal coalition.
failure of differentiation and segmetnation of primitive mesenchyme
- i.e. heritable defect (autosomal dominant)
- occurs in 1st trimester
What are some acquired etiologies of tarsal coalition?
arthritis
infection
trauma
neoplasm
What is syndesmosis?
fibrous union
*incomplete union w/ motion
what is synchondrosis?
cartilaginous union
*incomplete union w/ motion
what is synostosis?
osseous union
*complete union without motion
which tissue type classification of tarsal coalition will have NO motion?
synostosis
What is the Downey classification?
articular involvement
Describe the juvenile classification. what is the difference btwn type 1 and type 2?
type 1- extra-articular coalition
type 2- intra-articular coalition
What is the difference btwn type A and type B?
type A- no secondary arthritis
type B- secondary arthritis
note that adult and juvenile articular involvement classification is the same.
true
of the coalitions, which type is most common?
talocalcaneal coalition- 48.1%
calcaneonavicular coalition is next most common-43.6%
of the talocalcaneal coalition, which facet is the most common?
middle facet
what are some clinical findings related to tarsal coalition?
-limitation of motion
-rigid flatfoot
-muscle spasm
pain
*or asymptomatic!
When does talonavicular coalition appear?
3-5 years
when does calcaneonavicular coalition appear?
8-12 years
when does talocalcaneal coalition appear?
12-16 years
there is limitation of motion in STJ in tarsal coalition. which direction is limited?
STJ exhibits limited inversion
Why is peroneal muscle spasms seen with tarsal coalition?
due to painful STJ motion, the peroneal tendons guard to restrict motion to eversion and immobilize the joint
common sign or anteater sign is seen on which radiograph for which coalition?
seen on oblique radiograph of calcaneonavicular coalition
what is the comma sign or anteater sign?
on lateral view, the anterior calcaneus has an enlarged process that looks like an anteater nose or comma sign
halo sign is a radiographic finding of what tarsal coalition?
talocalcaneal coalition
what is the halo sign?
sclerotic enhancement of the sustentaculum tali
what radiographic findings are seen on lateral x-ray with a talocalcaneal coalition?
- diminished posterior or middle facet
- halo sign
- narrowing of posterior facet
- talonavicular beaking
- flattening of lateral talar process
on a calcaneal axial view, what would you see with talocalcaneal coalition?
facet obliquity
(normally facets are parallel or
is talonavicular beaking a secondary arthritic finding?
yes
if you saw talonavicular beaking on x-ray, how would you classify this?
type 2b because it is a secondary arthritic finding seen in a talocalcaneal coalition, which is intra-articular
what are some conservative treatment options for tarsal coalition?
NSAIDs PT shoe modifications padding orthotics casting
what surgical treatment would you use for a juvenile 1a?
resection w/ interposition of EDB
what surgical treatment would you use for a juvenile 1b?
triple arthrodesis
what surgical treatment would you use for a juvenile 2a?
- Resection w/ interposition of arthroereisis
- Isolated/single arthrodesis
- Triple arthrodesis
what surgical treatment would you use for a juvenile 2b?
triple arthrodesis
in general, if you had an extra-articuilar coalition without arthritis (i.e type 1a) how would you treat?
resection of bone + interposition
if you had a coalition with arthritis, how would you treat?
you fuse (except with juvenile 2a, you can do either resection or fusion)
what surgical treatment would you use for an adult 1a?
- Resection w/ interposition of EDB muscle
* Triple arthrodesis
what surgical treatment would you use for an adult 1b?
- Resection w/ isolated/single arthrodesis
* Triple arthrodesis
what surgical treatment would you use for an adult 2a?
- Isolated/single arthrodesis
* Triple arthrodesis
what surgical treatment would you use for an adult 2b?
Triple arthrodesis
in general, how would you treat adults?
with fusion, bc adults dont heal as well
