Tarsal Coalition

What is tarsal coalition?

The tarsal bones are located toward the back of your foot where your arch, heel and ankle meet. These bones work together harmoniously for proper foot function. Sometimes, however, there’s an abnormal connection between two or more of these bones. This is called a tarsal coalition.

Is tarsal coalition genetic?

Most cases of tarsal coalition are caused by genetic factors. However, it’s also possible to develop the condition due to infection, injury or arthritis.

Who does tarsal coalition affect?

Tarsal coalition generally affects children and teens, with symptoms beginning between the ages of nine and 16. However, the condition can develop in some adults as well.

How common is tarsal coalition?

Tarsal coalition only affects about 1% to 6% of the population. Approximately half of all people with tarsal coalition have issues with both feet (bilateral tarsal coalition).

How does tarsal coalition affect the body?

Children or adults with tarsal coalition may experience mild or severe symptoms, ranging from occasional aches and pains to walking difficulties and other functional issues.

Are there different tarsal coalition types?

Yes. There are several different types of tarsal coalitions. A coalition occurs whenever bone cartilage or fibrous tissue grows across the joints in your foot. Most commonly, this occurs between your talus (ankle bone) and calcaneus (heel) bones or your calcaneus and navicular bones. There are also other, more rare types of tarsal coalitions.

What causes tarsal coalition?

In most instances, tarsal coalition occurs when your foot bones develop improperly during fetal development. Tarsal coalition causes in adults include:

• Trauma.
• Arthritis in your joints.
• Infection.

What are the symptoms of tarsal coalition?

Many tarsal coalitions are never diagnosed because they don’t cause visible deformities or painful symptoms. Those who experience symptoms may notice:

• Pain or stiffness below their ankle, around the middle or back portion of their foot.
• Difficulty walking due to flat feet. (This can increase your risk for ankle sprains.)
• Increased pain with higher levels of activity.
• Symptoms following a minor foot or ankle injury.

The onset of these symptoms can vary significantly. Some people notice pain in late childhood or adolescence, while others may not develop symptoms until adulthood.

How is tarsal coalition diagnosed?

Your healthcare provider will examine your foot and ankle. They’ll also order imaging tests to help confirm your diagnosis. These tests may include:

• X-rays. These radiographic images give your healthcare provider an overview of your foot bones.
• CT (computed tomography) scans. This type of image shows greater detail compared to an X-ray. CT scans are commonly used to diagnose tarsal coalition.
• Magnetic resonance imaging (MRI). Unlike X-rays and CT scans, MRI scans provide images of soft tissues, as well as bones.

How is tarsal coalition treated?

Treatment is only recommended when tarsal coalitions cause symptoms. Tarsal coalition can be treated with surgical or nonsurgical methods, depending on the severity of the condition.

Nonsurgical tarsal coalition treatments

• Rest. Temporarily discontinuing activities that cause flare-ups can help reduce stress and alleviate pain. Typically, three to six weeks is sufficient.
• Injections. Steroid injections may be recommended to provide pain relief.
• Orthotics. Shoe inserts and arch supports can help stabilize your foot and ease discomfort.
• Boot or cast Immobilization. Wearing a temporary boot or cast can prevent movement and take extra stress off of your tarsal bones.
• Losing weight. If painful symptoms worsen with weight gain, talk to your healthcare provider about a personalized weight loss plan.

Surgical tarsal coalition treatments

• Resection. The most common surgical option for tarsal coalition, resection involves removing the coalition and replacing it with tissue or muscle from another area of your body. Resection can preserve normal foot function in most people.
• Fusion. Severe cases of tarsal coalition may be treated with joint fusion. During this procedure, your bones are held in place with screws, staples or plates to limit movement and place your bones in a more favorable position.

What if tarsal coalition is left untreated?

In some cases, people may experience enough pain and discomfort that it keeps them from the activities they enjoy. Left untreated, tarsal coalition can lead to a stiff foot later in life.

Are there complications of tarsal coalition surgery?

As with any surgical procedure, there are risks involved. Complications after tarsal coalition surgery may include:

• Infection.
• Hematoma.
• Poor wound healing.
• Poor bone healing.
• Nerve injury.
• Blood clot.
• Flail toes or hammertoes.
• Stiffness or weakness in your toe.

What are some tips for living with tarsal coalition?

At the first sign of a flare-up, you should stop any activity that could be contributing to your symptoms. Rest is often sufficient, but if you have persistent pain, schedule an appointment with your healthcare provider. They may recommend injections or orthotics to manage your discomfort.

How long does it take to recover from tarsal coalition surgery?

Healing time can vary from person to person. Typically, recovery after tarsal coalition surgery takes between six and 12 months. However, it may take longer depending on your age, severity of the condition and whether or not you have arthritis.

Can tarsal coalition be prevented?

In most cases, tarsal coalition is genetic, so it can’t be totally prevented. However, symptoms can be managed successfully with proper care.

What can I expect if I have tarsal coalition?

Many people with tarsal coalition don’t experience issues until late childhood or early adulthood. Some people may never develop symptoms.

When should I call my healthcare provider?

If you start noticing pain that doesn’t go away and stiffness, you should see your healthcare provider to establish a management plan. They can recommend treatment that’s tailored to your needs.

Can I play sports if I have tarsal coalition?

While sports can be more challenging for people with tarsal coalition, it’s possible to participate in athletics with the condition. If you’ve been diagnosed with tarsal coalition, ask your healthcare provider about any limitations.

A note from Cleveland Clinic

Tarsal coalition pain can be frustrating or debilitating and is sometimes hard to diagnose. Fortunately, there are diagnostic and therapeutic treatments available that can help ease your symptoms and improve your quality of life. Reach out to your healthcare provider for a personalized treatment plan.