What is Tarsal Coalition?

Tarsal coalition is a foot disorder that occurs due to an abnormal connection between two or more tarsal bones. These bones are located at the back of the foot and in the heel. Basically, with this condition, the bones tend to grow within one another and are joined together with the help of surrounding bones and cartilage. Tarsal coalition may result in severe flatfoot. It is usually inherited and remains asymptomatic until the child grows and enters early adolescence. The foot may become stiff and painful, and daily physical activities can become challenging. If left untreated, tarsal coalition may progress into foot arthritis.

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?

A foot and ankle specialist should be consulted. Your doctor will review your medical history, family history, and look for symptoms which include flatfoot, muscle weakness or stiffness, bone deformity, abnormal gait, and range of motion. Additionally, imaging tests such as X-ray, MRI (magnetic resonance imaging), or a CT (contrast tomography) scan may also be recommended to confirm the diagnosis.

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

A surgery of choice, bone resection involves removal and replacement of the abnormally connected tarsal bones with muscle or fatty tissues from another region in your body. It is the most commonly performed surgery as it preserves normal foot motion and relieves symptoms in most patients.

Tarsal Bone Fusion

The aim of this surgery is to restrict joint movement and align the bones properly. This helps corrects foot deformity, minimizes pain, and significantly improves signs and symptoms of arthritis. The tarsal bones at the back of the foot and in the heel are targeted and joined together with the help of pins, screws, plates, or rods.