TARSAL COALITION

 This condition occurs from an abnormal connection between two bones in the back of the foot known as tarsal bones.  This connection can be made of fibrous tissue, cartilage or bone.  Once this abnormal connection forms, it causes limited motion of the foot which leads to pain.  This is most often a hereditary condition, but can also be caused from arthritis or trauma.

Symptoms usually appear between the ages of 9-16 when the bones are beginning to mature.  Pain may not begin during this time, but may be seen later in life.  Signs of tarsal coalition may include pain with standing, walking or exercise, tired feet and legs, muscle spasm of the foot, severely flat foot and limited motion of the joints in the back of the foot.  Diagnosis begins with xrays, but they may not be the only tool we use to diagnosis this condition.  If the foot bones have not matured enough to see on plain xray, a CT or MRI may be necessary to see not only the bones, but the soft tissue around the painful area.

Treatment of tarsal coalitions can be addressed in two ways: conservative and surgical.  Conservative therapy includes physical therapy and anti-inflammatories to reduce pain and attempt to increase motion to painful areas that are restricted.  For adults, cortisone injections can be used to reduce pain and swelling as well.  For children, immobilization in a cast or walking boot will allow the foot to rest.  For all patients, a custom orthotic designed to control foot spasm and abnormal biomechanics is often the first line of defense.

When conservative treatment fails to provide pain relief or there is significant deformity, surgery is the next option.  Surgery for tarsal coalition is performed either to remove the abnormal connection allowing for more motion in the foot or to fuse the painful joint thus reducing the motion, but stopping the pain.  Which procedure is performed is based on a number of factors that will be determined by your podiatric surgeon.