Treatment for Tarsal Coalition

Causes, Symptoms, and Treatments of Tarsal Coalition

Tarsal coalition is a condition where two or more of the tarsal bones in the foot form an abnormal connection, leading to restricted movement and potential discomfort. The tarsal bones, located in the midfoot and hindfoot, are crucial for foot stability and mobility. In a healthy foot, these bones work together to distribute weight and facilitate smooth movement. However, when a tarsal coalition occurs, the bones fuse together, resulting in a rigid flat foot, pain, and other complications that can impact daily activities like walking or standing.

Tarsal coalition can affect both children and adults, though symptoms often become more pronounced as the bones mature. Early diagnosis and appropriate treatment for tarsal coalition are essential to prevent long-term issues and maintain foot health.

A foot with a tarsal coalition condition

Symptoms, Causes, and Treatment of Tarsal Coalition

What is Tarsal Coalition?
Tarsal coalition occurs when there is an abnormal connection between two or more of the tarsal bones in the foot. This connection can be fibrous, cartilaginous, or osseous (bone), and it restricts the normal movement of the foot. The tarsal bones, which include the calcaneus (heel bone), cuboid, cuneiform, navicular, and talus, are critical for weight distribution and propulsion during walking. When these bones fuse due to tarsal coalition, it can lead to a rigid flat foot, making walking or standing painful and difficult.

Tarsal coalitions often go unnoticed until later in childhood or adolescence, but they can also be diagnosed in adults, especially if symptoms such as pain and stiffness start to appear.

Tarsal Coalition Causes
The primary cause of tarsal coalition is genetic. It typically occurs during fetal development when the tarsal bones fail to separate properly. This congenital condition can be inherited, meaning it may run in families, or it can arise spontaneously without any family history. Less commonly, tarsal coalition can develop later in life due to an injury, infection, or arthritis.

In children, symptoms may not manifest immediately but typically emerge as the bones mature, usually between the ages of 9 and 16. In adults, symptoms can arise or worsen with age, especially if the condition was mild or undetected during childhood.

Symptoms of Tarsal Coalition
Whether in children or adults, the symptoms of tarsal coalition can vary widely. While some individuals may remain asymptomatic, others may experience significant discomfort. Common symptoms include:

→ Flatfoot

A rigid flat foot that lacks the typical arch and does not flex properly.

→ Leg Fatigue

Legs that tire easily or become fatigued quickly, especially during physical activity.

→ Foot and Ankle Stiffness

Limited range of motion in the foot and ankle, often accompanied by stiffness.

→ Pain

Mild to severe pain in the midfoot, particularly during or after walking or standing for long periods.

→ Gait Abnormalities

A noticeable outward turning of the foot while walking, which may be due to muscle spasms in the leg.

Diagnosing Tarsal Coalition
Diagnosing tarsal coalition requires a thorough approach that includes taking a full medical history and conducting a comprehensive physical examination. The healthcare provider will observe the patient’s gait for signs like foot collapsing and outward-pointing toes while walking.

During the physical exam, the patient may be asked to stand flat and then on their toes to see if the heel straightens. This helps assess the flexibility of the foot and the severity of the condition. However, because tarsal coalitions are not always evident during a clinical exam, imaging studies are crucial for accurate diagnosis.

Digital X-rays: These are typically the first step in evaluating the type and severity of the tarsal coalition. Common types include talocalcaneal or calcaneonavicular coalitions.
CT or MRI: If X-rays do not provide enough detail, a CT scan or MRI may be necessary. These imaging techniques offer a more comprehensive view of the bones and surrounding tissues, helping to pinpoint the exact location and extent of the coalition.

Conservative Treatment for Tarsal Coalition

Many individuals with tarsal coalitions respond well to conservative, non-surgical treatments. The goal of conservative treatment is to manage symptoms and improve foot function without the need for surgery.

→ Immobilization

The first step in treatment often involves immobilizing the foot, usually with a boot or cast. This helps "calm" the coalition by reducing inflammation and pain, allowing the patient to engage in normal activities with less discomfort.

→ Orthotics

Custom-made orthotic inserts can provide significant relief by supporting the foot and ensuring proper weight distribution. Orthotics help manage flatfoot and alleviate pain by improving the alignment and function of the foot.

→ Physical Therapy

Physical therapy may be recommended to strengthen the muscles around the foot and ankle, improve flexibility, and reduce symptoms like pain and stiffness. Therapy can also help correct gait abnormalities and prevent further complications.

When is Tarsal Coalition Surgery Necessary?

While conservative treatments are effective for many patients, some cases of tarsal
coalition may require surgical intervention. Surgery is typically considered when:

Persistent Pain: The patient continues to experience significant pain despite conservative treatment.
Severe Gait Abnormalities: Issues like a rigid flatfoot or outward-turning foot persist and interfere with daily activities.
Failure of Conservative Treatments: Non-surgical treatments do not improve symptoms or restore normal foot function.

Tarsal Coalition Surgery (Coalition Resection): Coalition resection is the most common surgical procedure for treating tarsal coalitions. During this outpatient procedure, the surgeon removes the abnormal connection between the tarsal bones, restoring foot mobility and alleviating pain. The best results and fastest recoveries occur when the surgery is performed on younger patients, ideally before the bones become fully mature.

Post-Surgery Recovery: After tarsal coalition surgery, most patients can bear weight in a walking boot immediately and transition back to regular footwear within about three weeks. Normal activities are gradually resumed as tolerated, with careful monitoring to prevent complications.

Tarsal Coalition FAQs

What is a tarsal coalition?

A tarsal coalition is an abnormal connection between two or more tarsal bones in the foot, limiting the foot’s motion and flexibility. This condition often leads to a rigid flatfoot and can cause pain, especially during physical activity.

What causes a tarsal coalition?

Tarsal coalitions are typically caused by a failure of the tarsal bones to separate properly during fetal development. The condition can be inherited genetically or occur spontaneously. The most common tarsal coalitions involve the calcaneus and talus or calcaneus and navicular bones.

Who is affected by tarsal coalitions?

Tarsal coalitions can affect both children and adults. Symptoms generally emerge in children between the ages of 9 and 16 as the bones mature, but adults may also experience symptoms if the condition was undetected or untreated in childhood.

How are tarsal coalitions diagnosed?

Diagnosis involves a thorough foot exam to assess the range of motion and check for rigid flatfoot. Imaging studies like X-rays, CT scans, or MRI are used to identify the abnormal bone fusion and determine the severity of the condition.

How are tarsal coalitions treated?

Nonsurgical treatment includes rest, immobilization casting, orthotics, and anti- inflammatory medications. If these measures fail to relieve pain and improve function, surgery to resect the coalition may be performed, particularly after skeletal maturity.

Conclusion

Tarsal coalition is a condition that requires careful management to prevent long-term issues like rigid flatfoot and pain. Early diagnosis and appropriate treatment are essential for ensuring the best outcomes for those affected by this condition. Whether through conservative measures like orthotics and physical therapy or surgical intervention, addressing tarsal coalition early can significantly improve quality of life.

If you or your child is experiencing symptoms of tarsal coalition, such as foot pain or gait abnormalities, it’s essential to seek expert care. Dr. Chandan Narang, a leading specialist in foot conditions, offers comprehensive treatment options tailored to each patient’s unique needs. With his extensive experience and commitment to patient care, Dr. Narang can help achieve the best possible outcomes. Schedule an appointment with Dr. Chandan Narang today to discuss your condition and explore the most effective treatment options for tarsal coalitions.