Thesis

138 Part I Chapter 5 patient with non-osseous TCC (middle facet). Pre-operative images show increased bone turnover at an irregular narrow joint space and subchondral cysts in both talus and calcaneus and no degenerative foci elsewhere in the foot or ankle (Figure 12). Figure 12. Same patient as Figure 11. Preoperative bone-SPECT/CT showed clearly increased bone turnover in a non-osseous TCC (middle facet), on accompanying low-dose CT an irregular narrow joint space and subchondral cysts in both talus and calcaneus. No degenerative foci elsewhere in the foot or ankle. CT, computed tomography; TCC, talocalcaneal coalition. The same patient was later treated with arthrodesis of the left subtalar joint because of TCC, however, patient continued to experience pain complaints. In this case, plain radiographs showed arthrodesis of the non-osseous TCC, without pinpointing the possible pain generator (Figure 13 panel A), as post-operative plain radiographs are often unable to pinpoint a specific pain generator after arthrodesis other than broken material, severe malalignments, or new fractures. Post-operative planar scintigraphy showed increased blood pool and bone turnover in the region of the left talocalcaneal articulation, which may indicate, but is non-specific for persisting TCC (Figure 13 panel B).

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