[Coalition 37] Accessory Anterolateral Talar Facet (AALTF) – Clinical Relevance in Coalition Imaging

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Definition

The AALTF is an anatomic variant where the posterior talar facet extends anteriorly, wrapping around the lateral talar process into the sinus tarsi. It represents an accessory talocalcaneal articulation, not a true separate ossicle.

Association with Tarsal Coalition

Studies confirm a strong link between AALTF and talocalcaneal coalition (TCC):

• Prevalence: 29% of patients with AALTF had a coalition vs. only 2% without (OR ≈ 16).
  
  
• Coalition type: Most commonly associated with extra-articular TCC and middle facet TCC.
  
  
• Shifted distribution:
  • With AALTF → talocalcaneal coalitions predominate (75%).
  • Without AALTF → calcaneonavicular coalitions predominate (78%).
  
  

Clinical & Imaging Implications

• Symptom overlap: Both AALTF and coalition can cause subtalar pain, peroneal spastic flatfoot, and altered hindfoot biomechanics.
  
  
• MRI findings: Best modality for detection. Look for:
  • Accessory facet cartilage extending anterior to lateral talar process.
  • Associated FABME (focal abutting bone marrow edema).
  • Sinus tarsi edema.
  
  
• Pitfall in management: Persistent lateral hindfoot pain may remain after coalition resection if an unrecognized AALTF is present.
  
  

Key Radiology Takeaway

Always evaluate for both coalition and AALTF together. Their coexistence is common and clinically significant, especially in patients with rigid flatfoot or unexplained lateral hindfoot pain.

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