Introdução: O Os sustentaculum é um osso acessório raro localizado na extremidade posterior do sustentaculum tali. A coalizão tarsal pode ser considerada uma anomaliacongênita que pode se tornar sintomática. Frequentemente, é necessária a TC ou a RM para confirmar o diagnóstico de coalizão talo-calcânea quando os achados nas radiografiassão ambíguos. Objetivo: Relatar um caso incomum de Coalizão da articulação talocalcaneana com Os sustentaculum, diagnosticado por exames de imagem. Relatodo Caso: Mulher de 26 anos com “caroço” no tornozelo direito há 10 anos promovendo dor intermitente. Apresenta piora ao usar salto – independentemente do tempo, ao andar ou ao ficar em posição ortostática por mais de 1 hora, referindo dor a palpação e irradiação para o pé. A radiografia do tornozelo direito apresenta ossículo acessório na porção medial da articulação talo-calcânea – Os sustentaculum, confirmada pela tomografia computadorizada. A ressonância magnética diagnostica coalizão talo-calcânea extra-articular com Os ustentaculum. Conclusão: É importante ressaltar que o Os sustentaculum não é apenasum ossículo acessório ou uma fratura antiga, ele é um componente de um tipo de coalizão talo-calcânea extra-articular, o que faz com que essa condição seja geralmente sintomática. Portanto, se um paciente com Os sustentaculum apresentar sintomas na área articular talo-calcânea medial, uma coalizão talo-calcânea extra-articular com Os sustentaculum deve ser considerada.
Palavras-chave: Coalizão tarsal, Tomografia computadorizada por raios X, Imagem por ressonância magnética, Radiografia
ABSTRACT
Introduction: The Os sustentaculum is a rare accessory bone located at the posterior end of the sustentaculum tali. The tarsal coalition can be considered a congenital anomaly that can become symptomatic. Often, CT or MRI is required to confirm the diagnosis of the talo-calcaneus coalition when the findings on radiographs are ambiguous. Objective: To report an unusual case of a coalition of the talocalcaneal joint with Os sustentaculum, diagnosed by imaging exams. Case Report: A 26-year-old woman with a “lump” in her right ankle for 10 years causing intermittent pain. She worsens when wearing heels - regardless of the time when walking or standing in an orthostatic position for more than 1 hour, referring to pain on palpation and irradiation to the foot. The right ankle radiograph shows an accessory ossicle in the medial portion of the talocalcaneal joint – Os Sustentaculum, confirmed by computed tomography. Magnetic resonance imaging diagnoses extra-articular talo-calcaneus coalition with Os sustentaculum. Conclusion: It is important to emphasize that the Os sustentaculum is not just an accessory ossicle or an old fracture, it is a component of a type of extra-articular talo-calcaneus coalition, which makes this condition generally symptomatic. Therefore, if a patient with Os sustentaculum shows symptoms in the medial talo-calcaneus joint area, an extra-articular talo-calcaneus coalition with Os sustentaculum should be considered.
Keywords: Tarsal coalition, X-ray computed tomography, Magnetic resonance imaging, Radiography
Hip joint overload injuries usually occur in sports practitioners, and presently, because of advances in diagnostic imaging tests, principally MRI, they are often diagnosed. Patients generally complain of pain at the proximal insertion of ITB (iliac tubercle: located posteriorly to the anterior superior iliac spine), exacerbated by Ober's maneuver and local palpation.MRI has an essential role in the diagnosis since the clinical picture can be confused with several diseases -intra and extra-articular circumstances of the hip. At this point, however, it should be noted that the examination should be requested not only for the investigation of the hip but rather to encompass the entire iliac, otherwise, the proximal portion of the ITB will not be properly analyzed. We intend to present a case of proximal iliotibial band syndrome, a recently described disease, still little known by physicians.
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