Congenital tarsal coalition is a diagnosis that is often overlooked in young patients who first present with foot and ankle pain. Calcaneonavicular and talocalcaneal coalitions are encountered most frequently; fusion at other sites is much less common. Tarsal coalitions may be osseous, cartilaginous, or fibrous. Calcaneonavicular coalitions are readily detected on oblique radiographs. Radiographic confirmation of talocalcaneal coalition is more difficult than for fusion at other locations, although several secondary radiographic signs may indirectly suggest the diagnosis. Computed tomography (CT) and magnetic resonance (MR) imaging are invaluable for assessment of tarsal coalitions because they allow differentiation of osseous from nonosseous coalitions and because they depict the extent of joint involvement as well as secondary degenerative changes, features of vital importance in surgical planning. Short-inversion-time inversion recovery MR images may reveal bone marrow edema along the margins of the abnormal articulation, an important clue to the diagnosis. Moreover, CT or MR imaging may be required to confirm the diagnosis of talocalcaneal coalition when radiographic findings are equivocal. Because the diagnosis of tarsal coalition is often not entertained by the clinician ordering a CT or MR imaging examination, multiplanar imaging of the ankle and hindfoot is required.

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Arthrography is considered extremely safe since reactions to intraarticular contrast media are rare. We have only seen one severe complication in the performance of more than 2,000 arthrographic procedures. To determine the incidence of complications, a questionnaire was sent to 84 radiologists experienced in arthrography. The 57 respondents had performed more than 126,000 arthrographic procedures, and findings of the survey indicate no deaths, three cases of infection, and 61 cases of hives. Other acute reactions included hypotension, seizures, air embolism, and laryngeal edema. Related complications included sterile chemical synovitis, severe pain after the procedure, and vasovagal reactions.