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Coalition by MSKMRI JEE EUN LEE.pdf
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- Posteromedial type bridging between sustentaculum tali and talus (~1/3 of all TCC).
- Os sustentaculum variant (~24% of TCC): intercalated ossicle forming pseudoarticulations with both talus and calcaneus → not a simple accessory bone.
- Frequently symptomatic: marrow edema on MRI, pain, and mass effect in the tarsal tunnel → tibial nerve compression (TTS), FHL/FDL impingement.
- Often coexists with intra-articular coalitions (esp. posterior facet).
Imaging
- Radiograph: May show ossicle posterosuperior to sustentaculum; classic signs (C-sign, talar beak) often absent.
- CT: Best for ossicle morphology and osseous changes (irregular margins, sclerosis, cysts).
- MRI: Key for non-osseous nature → fibrocartilaginous bridges, marrow edema correlating with symptoms, tenosynovitis/ganglion cysts possible.
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