PEDIATRIC RADIOLOGY: Musculoskeletal Radiology
Case Author: Ricardo Restrepo, MD, Miami Children’s Hospital
History
12-year-old male soccer player with right foot pain who reports no recent trauma when asked about it.
Imaging Findings
Lateral radiograph of the ankle (A) shows an elongated and prominent anterior process of the calcaneus (arrow). Sagittal STIR MR image (B) shows narrowing of the calcaneonavicular space with surrounding bone marrow edema (arrow). Sagittal T1-weighted MR image (C) shows the elongated anterior process of the calcaneus (asterisk) and articular surface irregularity on both sides of the calcaneonavicular joint with intervening cartilage (arrow).
- Calcaneal stress fracture
- Flexible pes planovalgus
- Juvenile idiopathic arthritis
- Tarsal coalition
Diagnosis
Tarsal coalition
Teaching Points
Early stress fractures can be radiographically occult. Owing to its contrast resolution, MRI can depict a fracture in its early stages. On radiographs, coalitions and flexible pes planovalgus share some features, but the presence of specific signs supports the diagnosis of coalition (talar beaking, broadening of the talar process, and the C and anteater signs). Coalitions can be osseous (synostosis), nonosseous (cartilaginous synchondrosis), or fibrous (syndesmosis). The term juvenile idiopathic arthritis refers to all forms of arthritis beginning before the age of 16 years that persist for more than 6 weeks and are of unknown origin. It has been classified in seven subtypes according to onset, number of joints affected, clinical findings, and presence of rheumatoid factor and HLA-B27.
Suggested Readings
Cass AD, Camasta CA. A review of tarsal coalition and pes planovalgus: clinical examination, diagnostic imaging and surgical planning. J Foot Ankle Surg 2010; 49:274–293
Zaw H, Clader JD. Tarsal coalitions. Foot Ankle Clin 2010; 15:349–364
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