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Coalition by MSKMRI JEE EUN LEE.pdf
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The middle subtalar joint is by far the most common site of talocalcaneal coalition.
Anatomy & morphology
- Occurs at the articulation between the sustentaculum tali of the calcaneus and the corresponding middle facet of the talus.
- Often involves the entire middle joint.
- Frequently associated with a dysmorphic sustentaculum tali (enlarged, rounded, or hypoplastic).
- On coronal MRI/CT: the normally horizontal or upward sloping facet instead slopes downward medially → the “drunken waiter sign.”
Imaging findings
- Radiographs (indirect signs):
- CT & MRI (definitive):
Clinical relevance
- Symptomatic presentation usually in adolescence (12–16 years).
- Restricted subtalar motion leads to pain, stiffness, rigid flatfoot, or peroneal spastic flatfoot.
- Recognition of this coalition type is essential since it represents the prototypical form of talocalcaneal coalition and has direct implications for surgical planning.
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