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Tarsal Coalition

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What is a tarsal coalition?
Causes
Symptoms
Diagnosis
Treatment 
Prevention
Outlook
FAQs

A tarsal coalition involves the abnormal fusion between two or more bones in the foot, between the heel and the midfoot. This can have a significant impact on a person’s mobility and their quality of life.

What Is A Tarsal Coalition?

Being diagnosed with a tarsal coalition means that you have an unusual connection or fusion of two or more bones in the tarsal region of the foot, which is at the hindfoot (the back of the foot). The bones involved in the coalition often include the calcaneus (heel bone), talus (one of the ankle bones), navicular (on the inside of the foot in front of the ankle), and sometimes the cuboid bone (in front of the ankle on the outside of the foot). 

As the bones are fused or otherwise abnormally connected, their movement is restricted. This can lead to pain and discomfort any time you’re on your feet, walking or active. A tarsal coalition is often congenital, meaning it is present from birth, but symptoms may not become apparent until later in childhood or adolescence when the bones are maturing and undergoing more stress.

What Causes A Tarsal Coalition?

A tarsal coalition is thought to have a genetic component in its development, such as from an error when the cells that form the tarsal bones are dividing in the womb. A tarsal coalition can also result from an infection, arthritis or an injury, or from specific conditions, such as fibrous tissue formation or cartilage anomalies between the bones. 

Symptoms Of A Tarsal Coalition

The main symptoms of tarsal coalition include pain and stiffness in the area where the bones are connected. This pain is typically aggravated by weight-bearing, such as prolonged standing and physical activity. You may also notice:

• A limited range of motion in the affected foot
  
• Difficulty performing activities that require significant flexibility of the foot joints 
  
• Depending on the coalition and the way the foot is affected over time, there may also be noticeable flattening of the arch
  
• Discomfort when walking over uneven surfaces
  
• Increased occurrence of foot and leg aches or fatigue
  

Diagnosis

Diagnosing a tarsal coalition involves a combination of a clinical evaluation with your podiatrist, imaging studies such as an x-ray or CT scan, and getting to know your history - such as when your symptoms started and what aggravates them. If we suspect that you may have a tarsal coalition, we’ll refer you for imaging so we can see the bones and the areas at which they are fused, giving us a very clear diagnosis and best helping inform the ideal management plan for you.

Treating A Tarsal Coalition

The best approach to treating a tarsal coalition depends on your current symptoms and their severity, the extent of bone fusion, and your age. While we can’t “get rid” of a tarsal coalition due to the nature of the condition, we do offer treatment solutions designed to optimise your comfort, reduce your pain and keep your feet supported and functioning well. Part of your care will include assessing your foot mechanics, evaluating your gait patterns, and identifying any abnormalities that might contribute to your discomfort and symptoms. The treatments we may use include:

• Custom foot orthotics: our orthotics are prescribed and designed uniquely for your feet, paying careful consideration to the way that your tarsal coalition is affecting the position and function of your foot or feet. We create our orthotics using a 3D scan paired with a comprehensive assessment by your podiatrist. We may design your foot orthotics to control and limit the motion at the affected joint, or strategically redistribute pressure away from the joint to help relieve pain and support mobility. We may choose to use a UCBL style orthotic that features a deeper heel cup to offer the best control for your foot and ankle, as this is a common need with a tarsal coalition due to movement restrictions. In some cases, we may recommend an ankle-foot orthotic instead, which encompasses the ankle.
  
• Footwear: your shoes play an important role in supporting your daily comfort and quality of life. Our podiatrists can recommend the best shoes for your specific foot type to offer you the best support while managing your tarsal coalition symptoms. We’re also one of the only clinics in the region that can make our own footwear modifications to your existing footwear to make them even better suited to the needs of your feet.
  
• Foot mobilisation: this is a hands-on therapy for stiff joints that is used quite successfully for less severe, fibrous coalitions (as opposed to bony coalitions). It helps to support movement in the joints and therefore lead to reductions in pain and improvements in a person’s comfort and mobility. 
  
• EXO-L brace: there is a higher rate of ankle sprains and ankle instability that we see in those with a tarsal coalition. If you have a history of repeated ankle sprains, we may recommend the EXO-L brace to be used together with your regular footwear as it is proven to prevent 95% of all ankle sprains.
  
• MLS laser: if your tarsal coalition is causing you significant pain and discomfort, we may recommend treatment with the MLS laser, which is a proven, painless and safe way to help manage a range of pains while reducing inflammation.
  
• Boot or brace immobilisation: in some severe cases of tarsal coalition, it may be best to offload and immobilise your foot and ankle. We have a range of options available to achieve this.
  
• Physical therapy: in some cases, working on your flexibility, muscle strength, or managing any muscle imbalances in your lower leg, foot or ankle can help reduce your pain and improve your daily comfort.
  

Surgery for a tarsal coalition

While the treatment options above are the first line of treatment, if following treatment your foot continues to cause you pain and create limitations on your daily life, surgery may be considered. We will refer you to a trusted orthopaedic surgeon who will discuss options including fusing the affected joints solidly, or removing additional bone to try to restore more normal motion between the bones involved in the coalition.

Prevention

As a tarsal coalition is primarily congenital and develops in the womb, a tarsal coalition is very difficult to prevent. However, early diagnosis and management can help prevent your symptoms from worsening and leading to greater pain and other complications. If your child is complaining of foot pain, always take them to see a podiatrist as soon as you’re able.

What Is The Outlook For Those With Tarsal Coalition?

With the right care, most of the patients that we work with can experience a reduction in pain and improvement in mobility - and therefore their quality of life on a daily basis. The results a person experiences will vary based on the severity of their coalition and the age at which their symptoms arise, but our podiatrists will always work with you to help you get the best results.

FAQs

Is a tarsal coalition common in both feet?

A tarsal coalition can develop in one or both feet, but it's not uncommon for the condition to be present in both. You can still have different symptoms and severity between the two feet.

Can a tarsal coalition be present without causing any symptoms?

Yes, a tarsal coalition can be present without causing noticeable symptoms. Some people will have a coalition but will only experience symptoms later in life when the bones and joints are subjected to more stress.

Can a tarsal coalition lead to other foot problems?

Yes, a tarsal coalition does have the potential to lead to other foot problems if left untreated, such as flatfoot deformities, altered gait patterns, and increased risk of arthritis in the affected joints.

Can adults develop tarsal coalition, or is it only present from birth?

While a tarsal coalition is primarily present from birth, it is possible for adults to develop symptoms later in life due to factors like increased physical activity, changes in biomechanics, or the gradual accumulation of stress on the affected area.