0:00

When we deal with neuropathic injuries,

0:04

we clearly can see bone collapse and fragmentation.

0:08

As you know, it is often the foot that's involved, the

0:13

hind foot midfoot or forefoot fragmentation

0:16

and disorganization are characteristic of

0:20

diabetic neuropathic osteoarthropathy.

0:23

You're going to hear as I look at the schedule,

0:25

more about the diabetic foot tomorrow,

0:28

and I would show you this case to remind you

0:32

that when you see unusual aversive injuries,

0:35

particularly in this location, this is what can happen

0:40

with diabetes as relates to neuropathic changes

0:44

with an avulsion at the site of attachment

0:47

of the achilles tendon.

0:50

We're gonna move on and talk a bit now about developmental

0:53

abnormalities and I'll do this rather rapidly.

0:56

The most important one is kalo Calcan coalitions.

1:00

Uh, the most co uh, common location

1:03

as I've already mentioned, are the middle facets of the TAs

1:06

and calcaneus involving the Susac Taylor.

1:10

There are in fact a number of classification systems.

1:13

I'm showing you images from one,

1:16

but most of the time we don't classify this other than

1:20

indicating is it a solid bone coalition

1:23

or is it fibro cartilaginous in nature?

1:28

Here's an example showing you a talo calcan

1:33

bone fusion solid involving the middle facets

1:37

of the Alis and calcaneus.

1:40

When you study this with conventional radiography,

1:43

this is uh, conventional tomography from a long time ago,

1:47

but look at this particular R beak that's known

1:50

as the Taylor beak and note the continuous C sign.

1:55

Alright, well recognized on lateral radiographs when dealing

2:00

with a bony coalition involving the middle facets.

2:05

I'm gonna show you a number of these now.

2:07

Here's again, another one probably bony

2:11

and solid note, the ball

2:13

and socket ankle joint that we discussed earlier.

2:17

Here is another one.

2:19

This one involving a slightly atypical

2:22

or a place between the talis

2:25

and calcaneus, fibro cartilaginous in nature.

2:28

And note the associated Osteoid Diskin scans

2:32

involving the Taylor dome.

2:35

A further example here, a fibro cartilaginous coalition

2:40

in the area of the middle facets of the Taylor

2:43

and Calcaneus.

2:45

And one further example showing you particularly

2:48

with the incomplete coalitions,

2:50

that you may have marrow edema in the adjacent bone.

2:57

There is an unusual type

2:58

Of coalition that occurs more posteriorly

3:02

on the medial aspect of the ankle

3:05

and really the hind foot,

3:07

and this is called an extra articular talo

3:11

calcaneal coalition.

3:14

It occurs at a level that is medial

3:16

to the posterior subtalar joint.

3:19

In this example, it is not solid bone,

3:22

but it is looks more like fibro cartilaginous tissue.

3:27

And one further example showing you an unusual coalition

3:31

posteriorly that would fit into the general category

3:34

of an extra articular talo calcan coalition with one

3:39

of the findings that has been emphasized by some

3:42

of the people here at UCSD

3:44

and enlarged bone prominence in this location,

3:49

which is designated in Antola Taylor facet,

3:55

you all recognize the Calcan Navicular Coalition

3:59

by the ant eater nose, something

4:02

in this case a Nonsolid Bone Coalition can be seen.

4:09

And one further coalition shown here, an unusual one, fibro,

4:14

cartilaginous in nature between the navicular

4:17

and medial canfor bones.