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Tarsal Coalition

A tarsal coalition is an abnormal connection that develops between two bones in the back of the foot (the tarsal bones). This abnormal connection, which can be composed of bone, cartilage or fibrous tissue, may lead to limited motion and pain in one or both feet.

The tarsal bones include the calcaneus (heel bone), talus, navicular, cuboid and cuneiform bones. These bones work together to provide the motion necessary for normal foot function.

Most often, tarsal coalition occurs during fetal development, resulting in the individual bones not forming properly. Less common causes of tarsal coalition include infection, arthritis or a previous injury to the area.

While many people who have a tarsal coalition are born with this condition, the symptoms generally do not appear until the bones begin to mature, usually around ages 9 to 16. Sometimes no symptoms are present during childhood; however, children may only have flatfeet as a symptom.

The symptoms of tarsal coalition may include one or more of the following:

  • Pain (mild to severe) when walking or standing
  • Tired or fatigued legs
  • Muscle spasms in the leg, causing the foot to turn outward when walking
  • Flatfoot (in one or both feet)
  • Walking with a limp
  • Stiffness of the foot and ankle
A tarsal coalition is difficult to identify until a child’s bones begin to mature at the age between 12-14 age. It is sometimes not discovered until adulthood. At most times a simple xray at our office will assess if this is the problem. Diagnosis includes obtaining information about the duration and development of the symptoms as well as a thorough examination of the foot and ankle. Sometimes an MRI or CT will be ordered to confirm and plan for surgery.

The goal of nonsurgical treatment of tarsal coalition is to relieve the symptoms and to reduce the motion at the affected joint. One or more of the following options may be used, depending on the severity of the condition and the response to treatment:

  • Oral medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be helpful in reducing the pain and inflammation.
  • Steroid injections. An injection of cortisone into the affected joint reduces the inflammation and pain. Sometimes more than one injection is necessary.
  • Orthotic or Brace devices. Custom orthotic devices can be beneficial in distributing weight away from the joint, limiting motion at the joint and relieving pain.
If the patient’s symptoms are not adequately relieved with nonsurgical treatment, surgery is an option. Tarsal coalition surgery is assessed depending on the amount of arthritis of the surrounding joints. If a patient’s weight on this condition, other joints become severely arthritic and the only formal treatment that is successful is a fusion of those arthritic joints. However this is diagnosed early and no surrounding joints have arthritic problems then a resection of the coalition is an option. This is another reason why early diagnosis is essential for maintaining and preserving joints of the foot and ankle.
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