Suggested Orthoses / AFO
A tarsal coalition is an abnormal connection of cartilage fibers between two or more bones in the rearfoot. Tarsal coalitions usually refer to abnormal connections between the talus and the calcaneus or the calcaneus and the navicular bones, but other bones can be referenced as well. This condition is likely to cause flatfoot due to rearfoot valgus and the excessive rigidity of the rearfoot. It’s estimated that 1-6% of the population have a tarsal coalition. Of those with tarsal coalitions, half of these people have the condition in both feet.
Tarsal coalitions may exist at birth and is considered a genetic driven condition, but symptoms usually only emerge as the bones mature and the child reaches their adolescent and teenage years. Pain and discomfort in the rearfoot develops gradually.
- Stiffness and pain that gets worse over long periods of time around the ankle and heel
- Rigid, flatfoot that decreases shock absorption and stability
- Frequent ankle instability, sprains and rolling of the ankle
- Pain increases during physical activity
A tarsal coalition requires time to diagnose because the child’s bones need to properly mature to determine the condition properly. To confirm a diagnosis, the clinician will need to review the patient’s medical history, perform a physical examination and possibly order imaging studies to evaluate the severity of the condition and to exclude any other possible conditions with similar symptoms.
The majority of cases in children can be treated with rest, NSAIDs, orthotics, braces or casts and physical therapy. A conservative treatment plan with these options can reduce the stress placed on the bones, alleviate pain and stabilize the structures of the foot.
If conservative treatments are not adequate to provide functionality and relieve pain, surgical treatments are an option. Common surgical treatments include resection, which consists of removal of the tarsal coalition, and joint fusion.