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Understanding Tarsal Coalition: Diagnosis and Treatment Approaches



Tarsal coalition is a relatively rare condition characterized by the abnormal fusion of two or more bones in the midfoot or hindfoot. This fusion restricts normal movement in the foot and can lead to pain, stiffness, and decreased mobility. Typically, these bones are separate during fetal development but fail to properly separate and remain fused together as the foot grows. While tarsal coalition can be challenging to diagnose and treat, there are various conservative and surgical approaches available to manage the condition effectively. The most common sites of tarsal coalition are between the calcaneus (heel bone) and the talus (ankle bone) or between the calcaneus and the navicular (a bone in the midfoot).


This abnormal fusion restricts normal movement in the affected joints, leading to pain, stiffness, and decreased mobility. Tarsal coalition often becomes symptomatic during childhood or adolescence, as the bones continue to grow and the demands on the foot increase with physical activity. Symptoms may include foot pain, particularly after physical activity or prolonged standing, stiffness in the foot and ankle, and difficulty walking or running. Often times the foot appears flat and rigid in the pediatric patient. Due to this rigidity the patient may develop muscle spasms especially on the outside (lateral) portion of the hind foot and leg.


Diagnosis: Diagnosing tarsal coalition often begins with a thorough evaluation by a healthcare professional, such as a podiatrist. During the evaluation, the healthcare provider will assess the patient's medical history, symptoms, and perform a physical examination of the affected foot and ankle. Diagnostic imaging tests, such as X-rays, CT scans, or MRI scans, may be ordered to visualize the bones and joints of the foot and confirm the presence of abnormal fusion. Additionally, a gait analysis may be conducted to evaluate the patient's walking pattern and biomechanics.


Conservative Treatment: Conservative treatment options may be recommended initially to manage symptoms and improve foot function in individuals with tarsal coalition. These may include:

  • Orthotic Devices: Custom foot orthotics or shoe inserts are often prescribed to provide support and alignment to the foot, reduce stress on the affected joints, and alleviate pain or discomfort.

  • Physical Therapy: Stretching and strengthening exercises may be prescribed to improve foot and ankle flexibility, strengthen supportive muscles, and enhance overall foot function.

  • Activity Modification: Avoiding high-impact activities or prolonged standing may help reduce symptoms and prevent exacerbation of tarsal coalition.


Surgical Treatment: In cases where conservative measures fail to provide adequate relief or if the tarsal coalition is causing significant functional limitations or pain, surgical intervention may be considered. Surgical procedures for tarsal coalition aim to release or remove the abnormal fusion, restore normal joint mobility, and improve overall foot function. Common surgical interventions for tarsal coalition include:

  • Coalition Resection: In cases where less than 50% of the joint is affected surgical removal of the abnormal bone fusion may be performed to separate the affected bones and restore normal joint movement.

  • Joint Fusion: In some cases, fusion of the affected joints may be necessary to stabilize the foot and alleviate pain. This involves surgically joining the adjacent bones with hardware such as plates and screws to prevent abnormal movement and reduce symptoms.


Overall, the diagnosis and treatment of tarsal coalition require a comprehensive approach tailored to the individual patient's needs and symptoms. With proper diagnosis and treatment, most individuals with tarsal coalition can experience significant improvement in symptoms and maintain an active and healthy lifestyle. It is essential for individuals experiencing foot pain or discomfort to consult with a healthcare professional for a proper evaluation and management plan.


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