Congenital Tarsal Coalition Part II Unit 6 Imaging

Congenital Tarsal Coalition: 

Congenital Tarsal Coalition By: Lacey Boudreaux and Lauren Chappetta Imaging October 12, 2011

What is it?: 

What is it? Congenital Tarsal Coalition is a genetic defect. It is an abnormal union between two or more bones in the hindfoot or midfoot . The union can be bony ( synotosis ) , fibrous( syndesmosis ) , or cartilaginous ( synchondrosis ) in nature.

Etiology : 

Etiology Two theories of etiology: 1.) One theory suggests failure of segmentation and differentiation of primitive mesenchyme results in coalition. 2.) Another theory proposed that accessory ossciles slowly ossify and incorporate into normal bone, resulting in the coalition.

Incidence: 

Incidence Found in approximately less than 1% of the population Typically presents in the 2 nd decade of life could be as early as 8 years of age 50 to 60% of patients have coalition bilaterally More common in males than females 90% involves either the calcaneonavicular articulation or the talocalcaneal articulation

What it looks like: 

What it looks like

Signs and Symptoms: 

Signs and Symptoms Some patient’s present asymptomatic Foot and or ankle pain Decreased motion Complaints of “Stiffness” Complaints of pain with increased activity or standing Patient history may include recent weight gain, increased athletic activity, and or trauma to ankle/foot

Clinical Presentation: 

Clinical Presentation P resents with painful rigid foot flat deformity Calcaneous Valgus deformity L ess common presentation peroneal spastic flatfoot where the peroneal muscle-tendon unit has shortened to adapt to the limited subtalar motion and hindfoot valgus Decreased Subtalar motion particularly in eversion and inversion

Treatment: 

Treatment I. Conservative approaches: NSAIDS to reduce pain Immobilization in cast/boot to reduce irritation Orthotics to aid in normalization of gait II. Surgical Repair: Excision of the abnormal bone replaced with fat, muscle, or tendon tissue in place of the bone Arthrodesis of the hindfoot

Prognosis: 

Prognosis Prognosis depends on location of coalition Calcaneonavicular Coalition yielded poor prognosis with conservative treatment often requiring surgery Talocalcaneal Coalition yielded good prognosis with conservative treatment Surgical procedures yielded good results for 80 to 100% of patients

What about Physical Therapy?: 

What about Physical Therapy? Physical therapy is utilized in two ways 1.) Conservative treatment to help reduce the irritation and normalize gait 2.)Post surgical to combat secondary effects of being immobilized and normalize functioning

Imaging: 

Imaging Imaging is required for diagnosis making imaging extremely important for this condition. Classically radiographs in an anteroposterior view, 45° Internal oblique view, and a lateral view are needed. Diagnosis with radiographs are followed with either CT Scans or MRI of the tissue in question.

Radiographs: 

Radiographs Calcaneonavicular Coalition (Lateral View)

Radiographs: 

Radiographs Calcaneonavicular Coalition (45° Medial Oblique View)

CT- Scans: 

CT- Scans Calcaneonavicular Coalition

CT- Scans: 

CT- Scans Talocalcaneal Coalition

MRI: 

MRI Calcaneonavicular Coalition

MRI: 

MRI Talocalcaneal Coalition

Questions: 

Questions What is physical therapy’s role in treating this condition? Please List some examples of treatment ideas. Why does this condition create pain at the ankle /foot specifically during activity or motion?

References: 

References Crim J., Kjeldsberg K. Radiographic Diagnosis of a Tarsal Coalition. American Journal of Roentgenology . February 2004 vol182. No2: 323-328. Claridge , Richard J. & Sakellariou, Anthony. Tarsal Coalition. Orthopedics . 1999;22(11)1066-1074 . Dutton , Mark. Orthopedic Examination, Evaluation and Intervention. York, PA: McGraw Hill Companies; 2004. Medical Multimedia Group, LLC. Images. http://www.eorthopod.com/content/tarsal-coalition . Accessed October 11, 2011.

References Continued…: 

References Continued… Newman, Joel S. & Newberg, Arthur H. Congenital Tarsal Coalition: Multimodality Evaluation with Emphasis on CT and MR Imaging. Radiographics. 2000;20(2):321-332. Salter, Robert B. System of Disorders and Injuries Textbook of the Musculoskeletal System 3 rd ed. Baltimore, MD: Williams & Wilkins. (1999). (pp. 141 ). Tarsal Coalition Talar Beak. Learning Radiology.com. Available at: http://www.learningradiology.com/archives2007/COW%20281-Talar%20beak/talarbeakcorrect.html Accessed on October 4, 2011. Tarsal Coalition. UW MSK Resident Projects. Available at http://UWMSK.ORG/resident projects/tarsal coalition.html . Accessed October 12, 2011. Vu P. Tarsal Coalition Treatment & Managment . MedScape Reference.Available at : http://emedicine.medscape.com/article/1233780-treatment#a1128 .Accessed on October 12, 2011.