Tarsal Bones Coalition Treatment

Tarsal coalition is an abnormal connection of two or more bones in the foot. The bones affected — called tarsal bones — are located toward the back of the foot and in the heel, and the connection of the bones can result in a severe, rigid flatfoot.Although tarsal coalition is often present at birth, children typically do not show signs of the disorder until early adolescence. The foot may become stiff and painful, and everyday physical activities are often difficult.

TARSAL COALITIONTHE CALCANEUS, TALUS, AND NAVICULAR ARE MOST COMMONLY INVOLVED IN TARSAL COALITION.

Pathophysiology

A tarsal coalition occurs when two bones grow into one another, connected by a bridge of bone, cartilage, or strong, fibrous tissue. These bridges are often referred to as “bars” and they can cover just a small amount of the joint space between the bones, or a large portion of the space.

The two most common sites of tarsal coalition are between the calcaneus and navicular bones, or between the talus and calcaneus bones. However, other joints can also be affected.

Natural History of Disease

In most people, the condition begins before birth. Although the coalition forms before birth, its presence is often not discovered until late childhood or adolescence.This is because babies’ feet contain a higher percentage of soft, growing cartilage. As a child grows, this cartilage mineralizes (ossifies), resulting in hard, mature bone. If a coalition exists, it may harden, too, and fuse the growing bones together with a solid bridge of bone or fibrous tissue similar to a scar. As a result, the hindfoot stiffens, causing pain and other symptoms. The stiffness and stress that tarsal coalitions produce may lead to arthritis over time.

X-RayX-ray image that shows a large tarsal coalition that has fused the talus and navicular bones together.

Symptoms

Many tarsal coalitions are never discovered because they do not cause symptoms or any obvious foot deformity. When symptoms do occur, they may include:

  • Stiff, painful feet. The pain usually occurs below the ankle around the middle or back half of the foot.
  • A rigid, flat foot that makes it difficult to walk on uneven surfaces. To accommodate for the foot’s lack of motion, the patient may roll the ankle more than normal, which may result in recurrent ankle sprains.
  • ncreased pain or a limp with higher levels of activity.

Imaging Modalities

To accurately diagnose the number, location and extent of the coalition(s), we will need images of your foot and ankle.

  • X-rays. These tests provide clear images of bone. Many coalitions are visible on x-rays.
  • Computed tomography (CT) scans. The images produced with computed tomography provide greater detail of the bones. CT scans are the gold standard for imaging tarsal coalitions because they can show more subtle bars that may be missed with plain x-rays.

CT_ImageCT image displays a cross-section view of the hindfoot and shows a large coalition fusing the talus and calcaneus bones

Treatment Modalities

Non Surgical treatment
  • Rest. Taking a break from high-impact activity for a period time — 3 to 6 weeks — can reduce stress on the tarsal bones and relieve pain.
  • Orthotics. Arch supports, shoe inserts like heel cups and wedges, and other types of orthotics may be recommended to help stabilize the foot and relieve pain.
  • Temporary boot or cast. These options can immobilize the foot and take stress off of the tarsal bones.
  • Injections. Steroid medications may be used in conjunction with other nonsurgical options to provide temporary pain relief.
Surgical treatment

When nonsurgical treatments are not effective at easing pain or improving function, surgery is recommended. The surgical procedure will depend on the size and location of the coalition, as well as whether the joints between the bones show signs of arthritis.

  • Resection. In this procedure, the coalition is removed and replaced with muscle or fatty tissue from another area of the body. This is the most common surgery for tarsal coalition because it preserves normal foot motion and successfully relieves symptoms in most patients who do not have signs of arthritis.