I have not shown the scarred ATFL and longitudinal split tear of the
peroneus brevis; they relate to the patient’s pain but are not
interesting.
There is medial pathology which, according to the referrer and patient, is
asymptomatic.
[image: axial.jpeg]
I assumed there would be medial symptoms because there is moderate FHL
tenosynovitis (there is no ankle joint effusion) in association with
subtalar coalition. There is a nice article by Erin Alaia etal in SkelRad
on the topic
[image: Screen Shot 2021-04-13 at 1.10.33 PM.png]
[image: 2.jpeg]
But what is different about this case is that this is an “extra-articular”
subtalar coalition, which occurs in the interval between the posterior
sustentaculum and posteromedial talar process. In these coronals the
sustentaculum looks normal and the subtalar joint looks normal in that
image. More posteriorly there is osseous overgrowth and articular
irregularly with non-osseous coalition.
There is a great article you should read by James Linklater et al.
[image: Screen Shot 2021-04-13 at 1.16.04 PM.png]
[image: 3.jpeg]
The coalition seems to be associated with an accessory articular facet;
this is reported as a normal variant which can be mistaken for
extra-articular coalition…though there seems to be both in this case (do
you agree???)
[image: 4.jpeg]
But this just goes to show that we can get excited about all sorts of
pathology that is apparently of no clinical relevance…because this
patient has no medial pain.
