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Coalition by MSKMRI JEE EUN LEE.pdf
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- Mechanism
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- Coalition mass effect: Non-osseous TCC (fibrous, cartilaginous) often shows bony excrescences or a dysmorphic sustentaculum tali encroaching into the tarsal tunnel.
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- Ganglion cysts: May arise from the fibrocartilaginous synchondrosis, decompress into the tarsal tunnel, and directly compress the tibial nerve and branches.
- Nerve Involvement
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- Most affected: Medial plantar nerve (MPN) → stretched or displaced along FHL.
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- Others: Lateral plantar nerve, calcaneal branches.
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- Imaging may show neuritis: nerve enlargement and increased T2 signal.
- Tendon Involvement
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- FHL and FDL most commonly impinged → tenosynovitis, tendinosis, split tears.
- MRI Findings
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- Coalition: Irregular margins, marrow edema, pseudarthrosis.
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- Ganglion cyst: Well-defined, fluid-intensity mass protruding into tunnel.
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- Nerve changes: Hyperintense, thickened MPN ± displacement.
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- Denervation: Edema or fatty atrophy in plantar muscles in chronic cases.
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