[Coalition 34] Calcaneonavicular Coalition – CT or MRI?

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One of the most frequent tarsal coalitions is the calcaneonavicular type. Radiographs may suggest it, but cross-sectional imaging makes the diagnosis clear.

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CT Highlights

• Shows the exact bony bar in osseous coalition.
  
  
• Non-osseous types → narrow/irregular joint space, subchondral sclerosis, cysts, and hypertrophy.
  
  
• Classic signs:
  • Anteater nose – elongated anterior calcaneus.
  • Reverse anteater – navicular extends laterally/posteriorly.
  
  
• Strength: Superb for osseous anatomy, surgical mapping.
  
  

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MRI Highlights

• Osseous: marrow continuity across calcaneus–navicular (T1 bright).
  
  
• Cartilaginous: cartilage-like bridge (T1 intermediate, T2 high).
  
  
• Fibrous: low-signal band with irregular facets.
  
  
• Key clue: bone marrow edema on STIR/T2 FS → symptomatic stress reaction.
  
  
• Extras: ganglion cysts, stress reactions, early OA.
  
  
• Strength: Superior for non-osseous coalitions & soft tissue.
  
  

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Radiology Perspective

• CT = best for bone.
  
  
• MRI = best for tissue, marrow, and subtle coalitions.
  Both are complementary, and recognition of secondary signs is essential for accurate diagnosis.
  
  

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