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Accessory bone behind the talus
2%
37/1574
Accessory bone adjacent to the navicular deep to tibialis posterior tendon
3%
46/1574
Anomaly between calcaneus and navicular
78%
1228/1574
Anomaly between calcaneus and talar dome
4%
56/1574
Anomaly between calcaneus and talar lateral process
13%
198/1574
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The so-called anteater sign is classic for a calcaneonavicular coalition, which is a structural anomaly between the calcaneus and navicular bones. Calcaneonavicular coalitions are the most common of the tarsal coalitions. They represent an aberrant osseous, cartilaginous, or fibrous union between the calcaneal and navicular bones. While nonoperative treatment (casting, orthoses, NSAIDs) is indicated as the first line of treatment for all coalitions, surgery is considered (resection or fusion) for all patients with recurrent or persistent pain after conservative treatment. Swensen et al. reviewed tarsal coalitions. They reported that patients often present between 8 and 12 years of age with complaints of nonspecific foot pain and often a history of recurrent ankle sprains. They highlighted that plain radiography is the initial step in evaluation and advanced imaging modalities are useful for preoperative planning, identifying fibrous and cartilaginous calcaneonavicular coalitions, and degenerative changes within the foot. Klammer et al. reviewed coalitions of tarsal bones. They reported that tarsal coalitions are the result of impaired mesenchymal separation of the tarsal bones, with the most common types being calcaneonavicular or talocalcaneal coalitions. They highlighted that subtalar stiffness results in pathologic kinematics with increased risk of ankle sprains and progressive joint degeneration. They concluded that coalition resection has good results and that tissue interposition may reduce the risk of reossification. Illustration A demonstrates the anteater sign, which is pathognomonic for a calcaneonavicular tarsal coalition. Illustration B demonstrates the C-sign which is seen in talocalcaneal coalitions. Incorrect Answers: Answer 1: This describes an os trigonum. Answer 2: This describes an accessory navicular. Answer 4: This describes a talocalcaneal coalition, which would be seen on radiographs as a C-sign (Illustration B). Answer 5: This kind of coalition has not been described.
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