- [Home](https://ortopediaevolutiva.com/en) - [Pediatric Orthopaedics Blog — Dr. Priano](https://ortopediaevolutiva.com/en/blog) - Tarsal Coalition: MRI Accuracy and the Role of CT # Tarsal Coalition: MRI Accuracy and the Role of CT February 18, 2026 2 min read Edited and medically reviewed by [Dr. Daniele Priano](https://ortopediaevolutiva.com/en/about) ![Tarsal Coalition: MRI Accuracy and the Role of CT](https://ortopediaevolutiva.com/blog-images/coalizione-tarsale-rm-accuratezza-neutral-v1.webp) This English version is based on the original Italian article. For wording nuances, you can refer to the Italian version. ## In short, for parents - • MRI is highly accurate for identifying tarsal coalitions. - • It shows soft tissues and inflammation without ionising radiation. - • CT can be useful for specific bone details or before surgery. Hindfoot pain, subtalar stiffness, and recurrent sprains are some situations where a tarsal coalition should be considered. X-rays can be uninformative, especially in incompletely ossified coalitions. CT has long been used as a reference method for defining bone anatomy. However, MRI has the advantage of also showing cartilage, bone edema, and soft tissue changes without using ionizing radiation. ## How Accurate is MRI? A retrospective study published in *European Radiology* assessed 56 patients with tarsal coalition and 112 controls, with a mean age of about 27 years: this was not an exclusively pediatric cohort. MRI had a cumulative sensitivity of 95.8% and specificity of 94.3%, with very high inter-observer agreement. These are study results, not guaranteed accuracy in an individual child or every type of coalition. [1] These results make MRI a valid diagnostic method even for identifying the coalition itself, not just for studying associated findings. ## What Does It Add Compared to CT? MRI can document bone edema, overload, impingement, and soft tissue changes that can contribute to symptoms. This is particularly useful in adolescents with pain and sports limitation but inconclusive X-rays. Furthermore, it avoids radiation exposure, a significant advantage in children when the necessary information can be obtained with both methods. ## When CT Remains Useful CT offers a very precise definition of bone anatomy and can still be useful in surgical planning, in complex coalitions, or when MRI does not sufficiently clarify the morphology. The choice therefore depends on the clinical question. To confirm a coalition and simultaneously evaluate associated causes of pain, MRI can often be sufficient. When detailed bone reconstruction is needed, CT retains a specific role. Disclaimer This content is for informational purposes only and does not replace a medical evaluation. In the presence of persistent pain, limping, foot stiffness, or repeated sprains, a specialist visit is prudent. References [1] Marth AA, et al. How accurate is MRI for diagnosing tarsal coalitions? A retrospective diagnostic accuracy study. European Radiology. 2024. PMID: 37855854. PubMed: [https://pubmed.ncbi.nlm.nih.gov/37855854/](https://pubmed.ncbi.nlm.nih.gov/37855854/) Full text (PMC): [https://pmc.ncbi.nlm.nih.gov/articles/PMC11126476/](https://pmc.ncbi.nlm.nih.gov/articles/PMC11126476/) ## Complete flatfoot pathway This article is a technical deep-dive into the accuracy of MRI in tarsal coalition. For the full clinical picture of flatfoot and rigid flatfoot, this is the reference pathway. - [1 Understanding flatfoot What it is, how the arch develops, and when an assessment is useful.](https://ortopediaevolutiva.com/en/conditions/flatfoot) - [2 When surgery may be needed Indications, arthroereisis techniques, risks and postoperative course.](https://ortopediaevolutiva.com/en/surgery/flatfoot) Adjacent clinical pictures: [Tarsal coalition](https://ortopediaevolutiva.com/en/conditions/tarsal-coalition) ![Dott. Daniele Priano](https://ortopediaevolutiva.com/assets/doctor-avatar-3d-CTvqnoPa.webp) ### Concerned about your child? If you recognize any of these signs in your child, a specialist assessment can give you clarity. I see children at Gaetano Pini and CTO institutes in Milan. 5.0 · Google & MioDottore [Book a private visit](https://ortopediaevolutiva.com/en/locations#prenota) ### Related Articles [Toe walking: when to consider surgery and what we know about recurrence in autism Read](https://ortopediaevolutiva.com/en/blog/toe-walking-when-surgery-recurrence-autism)[My child often trips and falls: when should I be concerned? Read](https://ortopediaevolutiva.com/en/blog/child-trips-falls-often-when-to-worry)[Children’s shoes worn on one side: what does it mean? Read](https://ortopediaevolutiva.com/en/blog/children-shoes-worn-on-one-side) ![Dott. Daniele Priano](https://ortopediaevolutiva.com/assets/doctor-avatar-3d-BiLSxBxW.webp) Author and medical reviewer ## Dr. Daniele Priano [Pediatric orthopaedic care in Milan](https://ortopediaevolutiva.com/en) — Gaetano Pini & CTO [Read full bio](https://ortopediaevolutiva.com/en/about) --- Canonical: https://ortopediaevolutiva.com/en/blog/tarsal-coalition-mri-accuracy Le informazioni cliniche sono divulgative e non sostituiscono una valutazione medica diretta.