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Ultrasonography01:17

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Ultrasonography or Radiography for Suspected Pediatric Talocalcaneal Coalition.

Xiong-Tao Li1, Xian-Tao Shen, Xing Wu

  • 1Department of Orthopedics Surgery, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China.

Journal of Pediatric Orthopedics
|September 11, 2025
PubMed
Summary

Ultrasonography accurately diagnoses pediatric talocalcaneal coalition, outperforming traditional radiography. This radiation-free method is superior for detecting even unossified cases in children.

Keywords:
C signpediatricradiographytalar beaktalocalcaneal coalitionultrasonography

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Area of Science:

  • Pediatric Orthopedics
  • Diagnostic Imaging
  • Musculoskeletal Radiology

Background:

  • Talocalcaneal coalition is a common tarsal coalition often underdiagnosed in children due to incomplete ossification.
  • Traditional radiographic signs like the "C sign" and "talar beak" have limitations in pediatric cases.
  • Ultrasonography offers a radiation-free alternative for evaluating unossified cartilage.

Purpose of the Study:

  • To evaluate the accuracy and reliability of ultrasonography compared to radiography for diagnosing suspected pediatric talocalcaneal coalition.
  • To assess the diagnostic performance of ultrasonography against 3D CT in pediatric patients.

Main Methods:

  • Eighty-six children with suspected talocalcaneal coalition underwent ultrasonography, radiography, and 3D CT.
  • Three pediatric orthopaedic surgeons assessed interobserver and intraobserver reliability of ultrasound and radiographic signs.
  • Sensitivity, specificity, and predictive values were calculated using 3D CT as the gold standard.

Main Results:

  • Ultrasonography showed high interobserver reliability (κ=0.87) compared to the "C sign" (κ=0.55).
  • Ultrasonography achieved 96% sensitivity and 98% specificity.
  • The "C sign" had 54% sensitivity and 86% specificity; the "talar beak" had only 11% sensitivity.

Conclusions:

  • Ultrasonography is a highly accurate and reliable method for diagnosing pediatric talocalcaneal coalition.
  • It surpasses radiography, particularly the "C sign" and "talar beak," in diagnostic performance.
  • Ultrasonography is suitable for detecting talocalcaneal coalition, including in cases with unossified cartilage.