Tarsal Coalition

Tarsal Coalition

What is Tarsal Coalition?

• Tarsal coalition is a condition in which two or more bones in the back part of the foot are abnormally connected. Instead of moving independently, these bones are joined together by bone, cartilage, or fibrous tissue, which limits normal foot motion. This can make the foot stiff and may lead to pain, recurrent ankle sprains, or the development of a flatfoot deformity.
• The condition is usually present at birth but often does not cause symptoms until late childhood or early adolescence, when the bones mature and movement becomes more restricted. As symptoms develop, everyday activities such as walking, running, or participating in sports may become uncomfortable or difficult. If not treated appropriately, tarsal coalition can place extra stress on nearby joints and may lead to arthritis over time.

What are the Causes of Tarsal Coalition?

• The exact cause of tarsal coalition is not clear. However, it may occur due to a mutation in the genes which affect the synthesis of cells in the tarsal bones.

What are the Symptoms of Tarsal Coalition?

• Tarsal coalition remains asymptomatic in the beginning. As the cartilage continues to harden, the disease may exhibit one or more of the following symptoms:
  • Flatfoot (in one or both feet)
  • Stiffness of the foot and ankle
  • Mild to severe pain when standing or walking
  • Leg weakness
  • Walking with a limp
  • Muscle contractions in the leg, causing the foot to turn outward when walking

How is Tarsal Coalition Diagnosed?

• An orthopedic surgeon should evaluate this condition. They will begin with a thorough review of your medical and family history and perform a physical examination of the foot and ankle. They will look for signs such as flatfoot deformity, stiffness or weakness, limited range of motion, changes in walking pattern, and areas of tenderness or bony prominence.
• Imaging studies are often used to confirm the diagnosis and better define the condition. These may include X-rays, an MRI (magnetic resonance imaging), or a CT (computed tomography) scan, depending on the suspected type of coalition and the patient’s symptoms.

What are the Treatment Options for Tarsal Coalition?

• Your doctor can treat tarsal coalition through a range of treatments that include:

Non-Surgical Treatments

• Oral medications such as nonsteroidal anti-inflammatory drugs (NSAIDs) to suppress pain and inflammation
• Cortisone (steroid) injections into the affected joint to suppress the pain and inflammation
• Physical therapy in the form of massage and exercises
• Orthotic devices such as insoles, ankle braces, and crutches to provide walking support
• Immobilization by a cast or splint to allow the affected foot to rest

Surgical Treatment

• Surgery is recommended for severe tarsal coalition and those cases which fail to heal through conservative management.
• Surgical procedures include:
  • Bone Resection
    • Resection surgery is often the preferred surgical treatment for tarsal coalition. This procedure involves removing the abnormal connection between the affected foot bones and placing soft tissue—such as muscle or fat—between the bones to prevent them from re-forming. By restoring separation between the bones, the goal is to improve motion, reduce pain, and relieve symptoms.
    • This is the most commonly performed surgical approach and is often successful in preserving normal foot movement, particularly in patients without significant arthritis or advanced deformity.
  • Tarsal Bone Fusion
    • The goal of this surgery is to limit painful joint motion and properly align the bones of the foot. By stabilizing the affected joints, the procedure can correct deformity, reduce pain, and significantly improve symptoms related to arthritis. During surgery, the involved tarsal bones in the back of the foot and heel are permanently joined together using surgical hardware such as screws, plates, pins, or rods to maintain proper alignment and stability.

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