Tarsal Coalitions

Question 1

What is a tarsal coalition?

Answer 1

when a union btwn 2 tarsal bones causes restricted motion or absence of motion

Question 2

What is a bar?

Answer 2

extra-articular coalition that occurs outside a normal joint

Ex. calcaneonavicular bar

Question 3

What is a bridge?

Answer 3

intra-articular coalition that occurs at a normal joint site

Ex. talocalcaneal bridge

Question 4

give some examples of extra-articular coalitions.

Answer 4

Calcaneonavicular

Cubonavicular

Question 5

give some examples of intra-articular coalitions.

Answer 5

talocalcaneal
talonavicular
calcaneocuboid
naviculocuneiform

Question 6

Describe the 4 classifications of tarsal coalitions.

Answer 6

1. etiology
2. anatomic
3. tissue type
4. articular involvement

Question 7

what is the most common cause of tarsal coalition in pediatric patients?

Answer 7

congenital etiology

Question 8

what is the most common cause of tarsal coalition in adult patients?

Answer 8

acquired etiology

Question 9

Describe Pfitzner’s theory of congenital cause of tarsal coalition.

Answer 9

incorporation of accessory ossicles into the normal tarsal bones

Question 10

Describe Leboucq’s theory of congenital cause of tarsal coalition.

Answer 10

failure of differentiation and segmetnation of primitive mesenchyme

• i.e. heritable defect (autosomal dominant)
• occurs in 1st trimester

Question 11

What are some acquired etiologies of tarsal coalition?

Answer 11

arthritis
infection
trauma
neoplasm

Question 12

What is syndesmosis?

Answer 12

fibrous union

*incomplete union w/ motion

Question 13

what is synchondrosis?

Answer 13

cartilaginous union

*incomplete union w/ motion

Question 14

what is synostosis?

Answer 14

osseous union

*complete union without motion

Question 15

which tissue type classification of tarsal coalition will have NO motion?

Answer 15

synostosis

Question 16

What is the Downey classification?

Answer 16

articular involvement

Question 17

Describe the juvenile classification. what is the difference btwn type 1 and type 2?

Answer 17

type 1- extra-articular coalition

type 2- intra-articular coalition

Question 18

What is the difference btwn type A and type B?

Answer 18

type A- no secondary arthritis

type B- secondary arthritis

Question 19

note that adult and juvenile articular involvement classification is the same.

Answer 19

true

Question 20

of the coalitions, which type is most common?

Answer 20

talocalcaneal coalition- 48.1%

calcaneonavicular coalition is next most common-43.6%

Question 21

of the talocalcaneal coalition, which facet is the most common?

Answer 21

middle facet

Question 22

what are some clinical findings related to tarsal coalition?

Answer 22

-limitation of motion
-rigid flatfoot
-muscle spasm
pain
*or asymptomatic!

Question 23

When does talonavicular coalition appear?

Answer 23

3-5 years

Question 24

when does calcaneonavicular coalition appear?

Answer 24

8-12 years

Question 25

when does talocalcaneal coalition appear?

Answer 25

12-16 years

Question 26

there is limitation of motion in STJ in tarsal coalition. which direction is limited?

Answer 26

STJ exhibits limited inversion

Question 27

Why is peroneal muscle spasms seen with tarsal coalition?

Answer 27

due to painful STJ motion, the peroneal tendons guard to restrict motion to eversion and immobilize the joint

Question 28

common sign or anteater sign is seen on which radiograph for which coalition?

Answer 28

seen on oblique radiograph of calcaneonavicular coalition

Question 29

what is the comma sign or anteater sign?

Answer 29

on lateral view, the anterior calcaneus has an enlarged process that looks like an anteater nose or comma sign

Question 30

halo sign is a radiographic finding of what tarsal coalition?

Answer 30

talocalcaneal coalition

Question 31

what is the halo sign?

Answer 31

sclerotic enhancement of the sustentaculum tali

Question 32

what radiographic findings are seen on lateral x-ray with a talocalcaneal coalition?

Answer 32

- diminished posterior or middle facet - halo sign - narrowing of posterior facet - talonavicular beaking - flattening of lateral talar process

Question 33

on a calcaneal axial view, what would you see with talocalcaneal coalition?

Answer 33

facet obliquity | (normally facets are parallel or

Question 34

is talonavicular beaking a secondary arthritic finding?

Answer 34

yes

Question 35

if you saw talonavicular beaking on x-ray, how would you classify this?

Answer 35

type 2b because it is a secondary arthritic finding seen in a talocalcaneal coalition, which is intra-articular

Question 36

what are some conservative treatment options for tarsal coalition?

Answer 36

``` NSAIDs PT shoe modifications padding orthotics casting ```

Question 37

what surgical treatment would you use for a juvenile 1a?

Answer 37

resection w/ interposition of EDB

Question 38

what surgical treatment would you use for a juvenile 1b?

Answer 38

triple arthrodesis

Question 39

what surgical treatment would you use for a juvenile 2a?

Answer 39

* Resection w/ interposition of arthroereisis * Isolated/single arthrodesis * Triple arthrodesis

Question 40

what surgical treatment would you use for a juvenile 2b?

Answer 40

triple arthrodesis

Question 41

in general, if you had an extra-articuilar coalition without arthritis (i.e type 1a) how would you treat?

Answer 41

resection of bone + interposition

Question 42

if you had a coalition with arthritis, how would you treat?

Answer 42

``` you fuse (except with juvenile 2a, you can do either resection or fusion) ```

Question 43

what surgical treatment would you use for an adult 1a?

Answer 43

* Resection w/ interposition of EDB muscle | * Triple arthrodesis

Question 44

what surgical treatment would you use for an adult 1b?

Answer 44

* Resection w/ isolated/single arthrodesis | * Triple arthrodesis

Question 45

what surgical treatment would you use for an adult 2a?

Answer 45

* Isolated/single arthrodesis | * Triple arthrodesis

Question 46

what surgical treatment would you use for an adult 2b?

Answer 46

Triple arthrodesis

Question 47

in general, how would you treat adults?

Answer 47

with fusion, bc adults dont heal as well