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The sustentaculum tali is a horizontal shelf that arises from the anteromedial portion of the calcaneus. The superior surface is concave and articulates with the middle calcaneal surface of the talus. The inferior surface has a groove for the tendon of flexor hallucis longus.
Several ligamentous structures attach to the sustentaculum tali:
plantar calcaneonavicular ligament (anterior surface)
deltoid ligament (medial surface)
The sustentaculum tali is typically involved in cases of tarsal coalition, specifically talocalcaneal coalition and subtalar coalition. In cases of talocalcaneal coalition, the complete C-sign can be seen on a lateral radiograph where there is bridging between the talus superiorly and the posterior portion of the sustentaculum tali inferiorly.
Fracture of the sustentaculum tali is rare, and usually not isolated. Such fractures usually occur in high-energy activities and should be suspected when the patient presents with pain and hematoma directly over the sustentaculum tali.