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Tarsal Coalition

 

Tarsal coalition describes an unusual connection between at least two bones in the hindfoot that is often detected in adolescence. It can make walking painful and tiresome while making you vulnerable to a range of other foot problems.

 

There are seven tarsal bones in your foot, located in the back section of the foot (as pictured). Having a tarsal coalition means that instead of these bones being connected by their regular joints and tissues, they are instead connected by either a bridge of bone, cartilage or strong fibrous tissue that severely limits their regular movement – and hence the normal function of the foot.

Tarsal coalitions most often develop in the womb during development, but symptoms don’t tend to appear until the bones begin to mature in the adolescent and teenage years. As such, some kids will not experience any symptoms in childhood or know that they have a coalition. When symptoms do begin, at whatever age that is, they may include:

 

  • Pain at the midfoot that can range from mild to severe, and may worsen over time
  • Limping 
  • Stiffness at the foot or ankle
  • Discomfort when participating in physical activity
  • A flatter, more rigid foot type
  • Difficulty walking over uneven surfaces
  • Being prone to foot and leg fatigue and aches
  • Muscle spasms, which may cause the foot to turn outwards when walking
  • Increased likelihood of ankle sprains

 

When a tarsal coalition doesn’t happen during fetal development, it may occur as a result of a previous injury to the area, an infection or arthritis.

 

Can You Fix It?

While a tarsal coalition can’t ‘go away’, our podiatrists help manage the symptoms of tarsal coalition to optimise your comfort, reduce your pain and keep your feet supported and functioning well. We have good outcomes with this approach, although the course of treatment can be heavily affected by which tarsal bones are affected, how many are affected, the way that they are affected, the movement left available in the area, and how your coalition is affecting your gait.

 

Tarsal Coalition Treatment

The first line management for a tarsal coalition is a non-surgical approach and non-symptomatic tarsal coalitions often do not require treatment. For painful tarsal coalitions, depending on your symptoms and severity, we may use:

 

  • Foot mobilisation: we are using this hands-on therapy for stiff and dysfunctional joints quite successfully for fibrous (less severe) coalitions, helping to ‘free up’ the joints and therefore see reductions in pain and improvements in comfort and mobility in our patients. 
  • Custom foot orthotics: these are designed specifically for your feet using a 3D scan and a comprehensive assessment by our podiatrists. They can work to control and limit the motion at the affected joint and strategically redistribute pressure away from the joint to help relieve pain and support mobility. Often with tarsal coalition we use a UCBL style advice with a deep heel cup to offer the best control for your foot and ankle.
  • Footwear: while we don’t sell any shoes, our podiatrists can recommend the best shoes for your specific foot type to help offer you the best support and comfort while managing your tarsal coalition symptoms. These shoes will also work as a team with your orthotics to help reduce your pain and improve your mobility and comfort. We can also make modifications to your existing footwear to help.
  • 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.
  • EXO-L brace: given the high incidence of lateral ankle instability and loose ligaments that we see together with tarsal coalition, we may recommend the slimline EXO-L brace to be used together with your regular footwear as it is proven to prevent ankle sprains.
  • NSAIDs: under advice from your doctor, non-steroidal anti-inflammatory medication may be used to help reduce pain.

If we do not see the results we want using these treatment protocols, we may refer you for corticosteroid injections if it is deemed clinically appropriate.

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Surgical treatment for a tarsal coalition

While the conservative treatment options above are the first line in treatment, if your foot continues to be painful and limiting, surgery may need to 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.

 

FAQs

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

This varies from person to person depending on the severity of the initial problem as well as a range of other personal and medical factors. In general, recovery from surgical treatment for tarsal coalition can take several months to a year or more.

 

Can tarsal coalition be prevented?

No, tarsal coalition is a condition that is typically present from birth and cannot be prevented.

 

Are there any exercises or physical therapy that can help with tarsal coalition?

Yes, part of your management will likely include a range of therapies including foot mobilisation and bracing to best support your recovery. Stretching or strengthening exercises may be provided where muscle weakness or stiffness is identified and is further complicating your symptoms and the coalition.

 

Can tarsal coalition cause long-term complications?

Yes, it’s very important to identify and treat tarsal coalition as it can lead to a range of unwanted complications. These include ongoing foot pain, limited mobility at the foot and ankle, arthritis, postural problems and even nerve damage.