609 - A Case of Symptomatic Talocalcaneal Coalition

An 18-year-old male with history of remote right ankle fracture and pes planus presented to physiatry clinic for lower extremity electromyography due to persistent right ankle pain and dysesthesias. Pediatric orthopedic evaluation five years prior included foot X-rays and MRI which showed concern for sinus tarsi syndrome, ankle impingement and non-specific marrow edema within the talus and calcaneus, which was treated with physical therapy and a controlled ankle motion orthotic. He reported feeling that his ankle was “stuck” and severely painful at times, which necessitated using crutches or crawling for mobility. A repeated MRI was consistent with previous findings, however, there was continued concern for bony abnormalities which prompted additional imaging. CT scanning showed talocalcaneal coalition that was not apparent on MRI, ao the patient was referred to podiatry. The patient ultimately underwent resection of talocalcaneal coalition with podiatry services and had significant reduction in his pain following his recovery.

Discussions:

Talocalcaneal coalition is an uncommon cause of midfoot or hindfoot pain and can be challenging to diagnose. Depending on the type and maturity of tissue forming the coalition, MRI or CT alone may be unable to fully visualize talocalcaneal fusions. Imaging findings with non-specific abnormalities in the mid and hindfoot should raise suspicion for coalition, particularly in patients with a history of foot and ankle trauma. Surgical resection is the treatment of choice in patients who have failed conservative therapies and have persistent foot dysfunction and pain.

Conclusions:

Symptomatic talocalcaneal coalition is a relatively rare cause of foot pain in young adults which can be difficult to visualize on conventional imaging and can be treated conservatively or surgically on a case-by-case basis.