Muenke syndrome is an autosomal dominant craniosynostosis syndrome resulting 
from a defining point mutation in the Fibroblast Growth Factor Receptor3 (FGFR3) 
gene. Muenke syndrome is characterized by coronal craniosynostosis (bilateral 
more often than unilateral), hearing loss, developmental delay, and carpal 
and/or tarsal bone coalition. Tarsal coalition is a distinct feature of Muenke 
syndrome and has been reported since the initial description of the disorder in 
the 1990s. Although talocalcaneal coalition is the most common tarsal coalition 
in the general population, it has never previously been reported in a patient 
with Muenke syndrome. We present a 7-year-old female patient with Muenke 
syndrome and symptomatic talocalcaneal coalition. She presented at the age of 7 
with limping, tenderness and pain in her right foot following a fall and strain 
of her right foot. She was treated with ibuprofen, shoe inserts, a CAM walker 
boot, and stretching exercises without much improvement in symptoms. A computed 
tomography (CT) scan revealed bilateral talocalcaneal coalitions involving the 
middle facet. She underwent resection of the talocalcaneal coalitions, remaining 
pain-free post-operatively with an improvement in her range of motion, gait, and 
mobility. This report expands the phenotype of tarsal coalition in Muenke 
syndrome to include talocalcaneal coalition. A literature review revealed a high 
incidence of tarsal coalition in all FGFR related craniosynostosis syndromes 
when compared to the general population, a difference that is statistically 
significant. The most common articulation involved in all syndromic 
craniosynostoses associated with FGFR mutations is the calcaneocuboid 
articulation.