Tarsal Coalition
What is a
Tarsal Coalition?
Atarsal 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.
![Tarsalcoalition]()
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.
Causes
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.
Symptoms
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 to16. Sometimes there are no symptoms during childhood. However,
pain and symptoms may develop later in life.
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
Diagnosis
A tarsal coalition is difficult to identify until a child’s bones begin to
mature. It is sometimes not discovered until adulthood. Diagnosis includes
obtaining information about the duration and development of the symptoms as
well as a thorough examination of the foot and ankle. The findings of this examination
will differ according to the severity and location of the coalition.
In addition to examining the foot, the surgeon will order
x-rays. Advanced imaging studies may also be required to fully evaluate the
condition.
Non-surgical
Treatment
The goal of non-surgical treatment of tarsal coalition is to relieve the
symptoms and 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.
- Physical
therapy. Physical therapy may include massage, range-of-motion
exercises, and ultrasound therapy.
- Steroid
injections. An injection of cortisone into the affected joint reduces
the inflammation and pain. Sometimes more than one injection is necessary.
- Orthotic
devices. Custom orthotic devices can be beneficial in distributing
weight away from the joint, limiting motion at the joint and relieving
pain.
- Immobilization.
Sometimes the foot is immobilized to give the affected area a rest. The
foot is placed in a cast or cast boot, and crutches are used to avoid
placing weight on the foot.
- Injection
of an anesthetic agent. Injection of an anesthetic into the leg may be
used to relax spasms and is often performed prior to immobilization.
When is
Surgery Needed?
If the patient’s symptoms are not adequately relieved with nonsurgical
treatment, surgery is an option. The foot and ankle surgeon will determine the
best surgical approach based the patient’s age, condition, arthritic changes,
and activity level.
Information provided by The American College of Foot and Ankle Surgeons