A tarsal coalition is a condition categorized by an abnormal connection of two or more of the bones in the foot. The affected tarsal bones lie toward the back of your foot in your heel, and the condition can lead to severe or rigid flatfoot if left untreated. Today, we take a closer look at why this condition develops, and how it is commonly treated by foot specialists.
Causes and Symptoms of Tarsal Coalition
The abnormal connection of the tarsal bones may be present shortly after birth, but physical signs of the abnormality typically don’t arise until early adolescence. The most common location for a tarsal coalition is between the calcaneus and navicular bones, or between the calcaneus and talus, but these are not the only areas that can be affected. About one percent of the population will deal with a tarsal coalition.
A tarsal coalition is caused by a gene mutation that impacts the cells that produce the tarsal bones, but again, this isn’t usually detected until late childhood. As the child grows, the tarsal coalition can ossify and fuse the growing bones together. Symptoms of the condition include:
- Foot or heel pain
- Stiffening of the hindfoot
- Rigid flatfoot
- Recurrent ankle sprains due to limited foot flexibility
- Inhibited gait
- Eventual arthritis formation
Diagnosis and Treatment of Tarsal Coalition
Tarsal coalitions are usually first suspected by a pediatrician or family doctor, especially if there are signs of a rigid flat foot or the child complains of heel pain. Your doctor will check for signs of an issue by examining your child’s foot flexibility and their gait. Other tests, like heel raises, can help look for signs of a flattened arch, which often accompanies the condition.
Saddled with these suspicions, your doctor will likely order some imaging tests to determine where the coalition exists and how it is formed. This can often be done with an X-ray, but a more detailed image can be provided with an MRI or CT scan, so any of those tests may be ordered.
The good news for patients diagnosed with a tarsal coalition is that the majority of them can be treated with conservative care. Rest from certain activities for a couple of weeks can reduce stress on the tarsal bones and in turn relieve pain. Other conservative options include orthotics to stabilize the foot, walking boots to take stress off the tarsal bones, temporary pain injections and physical therapy to strengthen other areas of the foot.
If conservative care fails to provide pain relief, surgery may be considered. Your exact surgery depends on the size and location of the coalition and if any of the bones have become arthritic. The most common surgical procedure is a resection operation where the coalition is removed and replaced with muscle or fatty tissue from another area of the body. This type of operation helps to preserve normal foot function and motion while successfully relieving symptoms in patients who do not have signs of arthritis. In more serious cases involving the onset of arthritis, a fusion operation may be conducted to limit movement of the painful joint and to help hold the bones in the proper position.
After surgery, you’ll be placed in a cast for a few weeks then transitioned to a walking boot. After a while, you’ll begin physical therapy exercises that focus on restoring strength and mobility in the ankle and foot. It usually takes a couple of months for full recovery, but most patients experience pain relief and improved foot motion after surgical recovery.