Tarsal Coalition

What is tarsal coalition?

Tarsal coalition is a developmental condition in which there is an abnormal connection between two or more tarsal bones. Tarsal bones are calcaneus, talus, navicular and cuboid bones that help in proper functioning of the foot.

How is tarsal coalition formed?

Tarsal coalition can occur across a joint between the talus and calcaneus (talocalcaneal coalition) in the foot or between calcaneus and navicular bones (calcaneonavicular coalition). An abnormal growth of bone cartilage and fibrous tissue causes pain and decreased range of motion of the foot. It is an inherited disorder and occurs as a result of failure of the differentiation of the cells that form the tarsal bones during the development of the fetus in the womb, infections, arthritis or injury to the area. Your child will not have symptoms until 8–16 years.

What are the symptoms of tarsal coalition?

The symptoms of tarsal coalition may vary with each child and may include the following:

  • Pain on the top of the foot
  • Flat feet
  • Muscle spasms
  • Rigidity or stiffness in the affected foot

How is tarsal coalition diagnosed?

Your pediatrician may ask you about your child’s medical history, following which a physical examination is done and an X-ray of the foot is taken. Other diagnostic tests, such as MRI and CT scan are done performed, to confirm the diagnosis and rule out other associated abnormalities.

What are the treatment options?

Several non-surgical and surgical treatment options are available for tarsal coalition. The objective of the non-surgical methods is to relieve pain and muscle spasm. The conservative approach includes custom-made orthotics such as shoe inserts recommended to support the affected joint, cortisone injection or an anesthetic injection given for temporary pain relief, and anti-inflammatory medications given to reduce pain.

Your pediatrician may recommend surgery if pain persists even after conservative treatment. Surgery depends on the type, site of coalition and whether arthritis is involved. If there is no arthritis, surgery involves resection of the union between the bones, thereby allowing normal range of motion to occur. In some cases, surgery involves fusion of the affected joints so as to limit the range of motion and reduce pain.

After the surgery, a splint or cast may be recommended along with crutches to immobilize the foot and prevent the foot from bearing weight while the healing happens. Your child can perform certain exercises that will help to restore the normal muscle tone and range of motion.