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What is a Tarsal Coalition?
A tarsal coalition is an abnormal
connection that develops
between two bones in the back of
the foot (the tarsal bones). This
abnormal connection—which can
be composed of bone, cartilage,
or fibrous tissue—may lead to
limited motion and pain in one
or both feet.
The tarsal bones include the
calcaneus (heel bone), talus,
navicular, cuboid, and cuneiform
bones. These bones work together to
provide the motion necessary for
normal foot function.
Tarsal coalition is a condition
most often caused by a hereditary
defect that occurs during fetal
development and results in the
individual bones not forming
properly. Less common causes of
tarsal coalition include infection,
arthritis, or a previous injury to
the area.
Signs and Symptoms
While many people who have a
tarsal coalition are born with this
condition, the symptoms generally
do not appear until the bones begin
to mature—usually around ages
9 to 16. Sometimes there are no
symptoms during childhood.
However, pain and symptoms may
develop later in life.
The signs and symptoms of tarsal
coalition may include one or more
of the following:
• Pain (mild to severe) when
walking or standing
• Tired or fatigued legs
• Muscle spasms in the leg,
causing the foot to turn outward
when walking
• Flatfoot (in one or both feet)
• Walking with a limp
• Stiffness of the foot and ankle
Diagnosis
A tarsal coalition is difficult to
identify until a child’s bones begin
to mature. Diagnosis includes
obtaining information about the
duration and development of the
symptoms as well as a thorough
examination of the foot and ankle.
The findings of this examination
will differ according to the severity
and location of the coalition.
In addition to examining the foot,
the surgeon will order x-rays.
Additional diagnostic imaging
tests—such as a CT scan or MRI—
may also be needed.
Treatment: Non-Surgical
Approaches
The goal of non-surgical treatment
of tarsal coalition is to relieve the
symptoms and reduce the motion at
the affected joint. One or more of
the following options may be used,
depending on the severity of the
condition and the response to
treatment:
• Oral medications. Nonsteroidal
anti-inflammatory drugs
(NSAIDs), such as ibuprofen,
may be helpful in reducing the
pain and inflammation.
• Physical therapy. Physical therapy
may include massage, range-ofmotion
exercises, and ultrasound
therapy.
• Steroid injections.An injection
of cortisone into the affected
joint reduces the inflammation
and pain. Sometimes more than
one injection is necessary.
• Orthotic devices. Custom
orthotic devices can be
beneficial in distributing
weight away from the joint,
limiting motion at the joint,
and relieving pain.
• Immobilization. Sometimes the
foot is immobilized to give the
affected area a rest. The foot
is placed in a cast or cast boot,
and crutches are used to avoid
placing weight on the foot.
• Injection of an anesthetic agent.
Injection of an anesthetic into
the leg may be used to relax
spasms and is often performed
prior to immobilization.
When is Surgery Needed?
If the patient's symptoms are not
adequately relieved with nonsurgical
treatment, surgery is an
option. Surgery could involve
removal of the abnormal connection,
or fusion (permanent stiffening) of
the joint. The foot and ankle surgeon
will determine the best surgical
approach based the patient's age,
condition, arthritic changes, and
activity level.
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