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Calcaneonavicular coalition = abnormal union between the anterior calcaneal process and navicular.
It may be osseous, cartilaginous, or fibrous — and imaging provides the key clues.
Imaging Features
- Osseous type → complete bony bar with marrow continuity.
- Cartilaginous type → cartilage-like bridge, intermediate T1, high T2.
- Fibrous type → low-signal band, irregular joint margins.
- Secondary changes → subchondral sclerosis, cysts, hypertrophy, and bone marrow edema at stress points.
- Classic signs:
• Anteater nose – elongated anterior calcaneus.
• Reverse anteater – lateral/posterior extension of navicular.
• Talar beak – traction osteophyte from abnormal biomechanics. - Frequently associated with rigid flatfoot and restricted subtalar motion.
Radiology Perspective
Recognizing direct bridging and these secondary signs is critical. Imaging not only confirms the diagnosis but also highlights the coalition’s morphology and stress response, guiding management and surgical planning.
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