Tarsal Coalition: Throw the kitchen sink at it

A tarsal coalition is a condition that is characterized by the abnormal fusion of two or more bones in the tarsal region of the foot. The fusion may be fibrous tissue, cartilage or bone. The most common is the medial talocalcaneal (talus and calcaneus), calcaneonavicular (calcaneus and navicular), posterior talocalcaneal and talonavicular (talus and navicular), but any of the bones in the tarsus region of the foot can be affected. It is thought to affect around 1% of children and adolescents.

Cause of a Tarsal Coalition

The exact cause of tarsal coalition is not clear and is probably a congenital condition and is present from birth. The symptoms usually don’t become apparent until late childhood or adolescence when the bones are more developed.

Symptoms of a Tarsal Coalition

The symptoms of a tarsal coalition will vary substantially from person to person, depending on at what age that they appear and which of the tarsal bones are involved.

Common symptoms associated with a tarsal coalition typically include foot and ankle pain that gets worse with activity and relieved with rest. There will be a stiffness and a limited range of motion in the affected joint. There is often fatigue and an abnormal gait (eg limp). A flat foot may develop.

The diagnosis is always going to be made based on imaging (x-ray, CT scan or MRI) which will demonstrate the bone bridge between the bones.

Treatment of a Tarsal Coalition

The treatment typically starts with pain relief. This could mean the use of ice and NSAID’s. Activity levels may need to be restricted.

Strapping or tape can be used to the hold the foot and joints in such a position that limits the movement or motion that is painful. It that does not help, then a short leg cast immobilization or walking brace may be needed for around 6 weeks.

Foot orthoses can also be used to restrict motion in the joints that are painful. This is done by using them to hold or support the foot in its least painful position or alignment.

Surgical resection of coalition is needed if the conservative treatments are unsuccessful and pain is persistent.