[Coalition 08] Medial Talocalcaneal Ligament: The Normal Variant That Mimics Coalition

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[Coalition 08] Medial Talocalcaneal Ligament: The Normal Variant That Mimics Coalition

The medial talocalcaneal ligament is an extra-articular structure that radiologists must recognize to avoid overcalling a fibrous coalition.

Anatomy

• Variably present, spanning from the antero-inferior postero-medial talus to the posterior sustentaculum tali.
  
  
• Sometimes arises just anterior to the postero-medial process.
  
  

MRI appearance

• Best seen on sagittal and coronal PD images.
  
  
• Appears as a narrow or multi-fascicular bundle with smooth cortical attachments.
  
  
• Differentiating clue: no adjacent bony deformity.
  
  

Clinical relevance

• Fibrous talocalcaneal coalition in adults usually causes irregular cortical changes or bony remodeling at the entheses.
  
  
• The medial talocalcaneal ligament has smooth margins without deformity → normal variant, not coalition.
  
  

Correctly identifying this ligament prevents misdiagnosis and unnecessary concern for coalition.

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