Surgical management of symptomatic talocalcaneal coalitions by resection of the sustentaculum
Hyer, "Evans osteotomy and risk to subtalar joint articular facets and sustentaculum
tali: a cadaver study," Journal of Foot and Ankle Surgery, vol.
The articular facets of the sustentaculum
tali have different configurations, but because they influence subtalar joint stability they are functionally important (Anjaneyulu et al.).
In the other model the calcaneus was fixated with the same AO calcaneal plate together with an additional screw being infiltrated into the sustentaculum
(18) Absent visibility of the subtalar facets (usually middle subtalar facet) and a dysmorphic sustentaculum
tali are also helpful in diagnosing talocalcaneal coalition on a lateral x-ray of the foot, however the accuracy of these signs can be confounded by the direction of the x-ray beam.
A third line marks the border of the sustentaculum
. The lines are labelled A to C from lateral to medial.
The strongest portion of the superficial deltoid is the calcaneotibial ligament, which inserts at the sustentaculum
Medial downsloping of the sustentaculum
tali articulating surface (Figure 3) instead of the normal lateral slope and presence of a dorsal talar spur (not to be confused with the physiologic, more proximal dorsal spur at the capsular insertion) are useful ancillary findings.
In dancers, FHL tendinopathy, posteriorly and plantarly to the medial malleolus and sustentaculum
tali, regularly coincides with PAIS (estimates vary between 26% and 63%) (5,6) and sometimes is referred to as "dancers' tendinitis." (7,8) The etiology of FHL tendinopathy in dancers is not fully understood.
In addition, such talar articulating facets associated with sustentaculum
tali facet of calcaneal bone are involved in major stability of subtalarjoint (Drayer-Verhagen, 1993).
By doing so and by releasing the superficial part of deltoid ligament, by detaching the spring ligament from sustentaculum
tali and by dividing the talocalcaneal interosseous ligament and bifurcated ligament the navicular is completely mobilized and reduced onto the head of talus.
Additional imaging findings, including marrow edema and fractures, and associated secondary signs, such as talar "beaks," the "anteater" (hyperplastic anterior calcaneal process) sign, and the innovative "reverse anteater" (hyperplastic navicular) and "drunken waiter" (hypo/dysplastic sustentaculum
tali) signs, were reported as well.