122 Part I Chapter 5 Background Tarsal coalition (TC) is an abnormal congenital connection (fibrous, cartilaginous, or osseous) between two or more bones in the hind- and midfoot, which may result in limitation of foot motion and development of pain [1]. TCs are also known to be the cause of painful flatfoot (pes planus) in adolescents and young adults [1, 2]. The vast majority consists of calcaneonavicular (CNC) or talocalcaneal coalitions (TCC) and are often asymptomatic. In patients with complaints of pain, appropriate imaging is needed for definite diagnosis, starting with plain radiographs of the foot. In insufficiently explained symptomatic patients, advanced imaging using CT, bone scintigraphy with [99mTc]Tc-diphosphonate Single Photon Emission Computed Tomography / Computed Tomography (bone-SPECT/CT), or Magnetic Resonance Imaging (MRI) may more precisely characterize the condition in either primary diagnosis or during follow-up, guide in surgical approach, and thus improve patient care. Specific literature is still limited about findings on bone-SPECT/CT in patients with TCs, however. This article reviews the characteristics and patterns on boneSPECT/CT in patients with TCs and in relation to clinical complaints and to other imaging techniques. Design and aims Publication design Evidence-based review of the value of bone-SPECT/CT in TC in relation to clinical symptoms, outcome, and its role compared to radiological features on plain radiographs and MRI for the three types of tarsal coalitions (fibrous, cartilaginous, or osseous) and for the two most anatomically prevalent TCs (CNC and TCC). This review is illustrated with cases typical for TC patients’ clinical management from an academic hospital with specialized foot surgery with consecutive plain radiographs, MRI, and high resolution/quality bone-SPECT/CT images to exemplify the additional value of bone-SPECT/CT compared to other modalities. Compliance with ethical standards Conflicts of interest: None Ethical approval and consent to participate and publication: the ethics committee has officially waived informed consent for this review (reference number 2022-00121).