Tarsal coalition (also known as peroneal spastic flatfoot, tarsal synostosis, or tarsal dysostosis) is an abnormal connecting bridge of tissue between two normally-separate tarsal bones.
What is a tarsal coalition in the foot?
The bones of the foot found at the top of the arch, the heel, and the ankle are called the tarsal bones. A tarsal coalition is an abnormal connection between two or more of these bones. These coalitions can form across joints in your child’s foot or can occur between bones that don't normally have a joint between them.
What bones are affected by tarsal coalition?
Tarsal coalition affects the bones in the midfoot and heel, which are called the tarsal bones. There are several different forms of tarsal coalition. Any of the seven tarsal bones could be affected, but the calcaneus, navicular, and talus bones are the ones most commonly involved.
When do symptoms of Tarsal coalition appear?
This genetic condition typically develops before birth, but symptoms usually aren’t apparent until late childhood or early adulthood. What is tarsal coalition? The tarsal bones are located toward the back of your foot where your arch, heel and ankle meet.
What is the best non-operative treatment for tarsal coalition?
Non-operative treatment for tarsal coalition includes: Rest: Avoiding aggravating activities for 4-6 weeks reduces the stress on the tarsal bones and can reduce pain Shoe Inserts: Orthotics e.g. heel wedges or arch supports can be used to correct abnormal foot position, stabilize the foot and reduce the forces going through the affected joint
What causes tarsal coalition?
Causes. In most cases, tarsal coalition is caused by a gene mutation that disrupts the normal prenatal development of bones in the foot. Less frequently, the condition has been linked to infections, injuries or arthritis.
Does tarsal coalition go away?
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.
How rare is a tarsal coalition?
Experts estimate that about 3 to 5 percent of people have a tarsal coalition. About 50 percent of these individuals have it in both feet.
Can I run with tarsal coalition?
The connection can be osseous (bone), cartilaginous or fibrous. 90% of tarsal coalitions are either talocalcaneal (intra-articular) or calcaneonavicular (extra-articular) (Franson & Baravarian, 2004). They can cause pain, limited movement during walking and running and muscle spasm (Downey, 2011).
Is tarsal coalition a foot deformity?
Tarsal coalition is a common cause of rigid deformity of the hindfoot and can also be associated with flatfoot. The incidence of tarsal coalition has been reported to be between 2% and 13%, with roughly half of patients having bilateral coalitions.
Does tarsal coalition show up on xray?
Background. Tarsal coalitions affect up to 13% of the population and can be a cause of chronic ankle and hindfoot pain. They can be subdivided as osseous, cartilaginous, or fibrous types, each with unique radiographic, CT, and MR imaging findings.
What causes foot bones to fuse together?
The most common reason for midfoot fusion is painful arthritis in the midfoot joints that has not improved with non-surgical treatment. Other common reasons to do a midfoot fusion include too much motion of one or more of the midfoot joints or deformity of the midfoot.
What is tarsal coalition?
A tarsal coalition is an abnormal connection of two or more bones in the foot. The bones affected — called tarsal bones — are located toward the back of the foot and in the heel, and the connection of the bones can result in a severe, rigid flatfoot. Although tarsal coalition is often present at birth, children typically do not show signs ...
Why are tarsal coalitions never discovered?
Many tarsal coalitions are never discovered because they do not cause symptoms or any obvious foot deformity. When symptoms do occur, they may include:
What is the gold standard for imaging tarsal coalitions?
CT scans are the gold standard for imaging tarsal coalitions because they can show more subtle bars that may be missed with plain x-rays. This CT image displays a cross-section view of the hindfoot and shows a large coalition fusing the talus and calcaneus bones.
How to help tarsal bones?
Rest. Taking a break from high-impact activity for a period time — 3 to 6 weeks — can reduce stress on the tarsal bones and relieve pain. Orthotics. Arch supports, shoe inserts like heel cups and wedges, and other types of orthotics may be recommended to help stabilize the foot and relieve pain. Temporary boot or cast.
What is the procedure to remove tarsal coalition?
Resection. In this procedure, the coalition is removed and replaced with muscle or fatty tissue from another area of the body. This is the most common surgery for tarsal coalition because it preserves normal foot motion and successfully relieves symptoms in most patients who do not have signs of arthritis.
What does flat arch mean in tarsal coalition?
Patients with tarsal coalitions may have a flat arch that does not fully correct when pushing up on the toes and raising the heel. (Left) A side view of a young person with flat foot. (Right) The feet remain flat when performing a toe raise.
Why is coalition disorder so hard to diagnose?
In most people, the condition begins before birth. It is caused by a gene mutation that affects the cells that produce the tarsal bones.
What Is Tarsal Coalition?
Tarsal coalition affects the bones in the midfoot and heel, which are called the tarsal bones. There are several different forms of tarsal coalition.
How Is Tarsal Coalition Diagnosed?
In adolescents, tarsal coalition is sometimes discovered because their bones are ossifying.
What is the Calcaneocuboid coalition?
Calcaneocuboid coalition, talonavicular coalition, and cubonavicular coalition: Calcaneocuboid coalition involves the calcaneus and the cuboid (located on the bottom of the foot) bones; talonavicular coalition involves the talus and the navicular bones; and cubonavicular coalition involves the cuboid and navicular bones. These forms of tarsal coalition are very rare.
What is a talocalcaneal coalition?
Talocalcaneal coalition (or talocalcaneal bar): In this form of tarsal coalition, the calcaneus bone and the talus bone (the ankle bone) are involved. As in calcaneonavicular coalition, the connection between the calcaneus and the talus could be partial or complete, and could be made of bone, cartilage, or fibrous tissue.
What percentage of people have tarsal coalition?
It’s estimated that anywhere from 1 to 3 percent of the population have this condition, which is typically diagnosed in children and adolescents. In tarsal coalition, two or more bones in the heel or the midfoot do not separate properly during fetal development, which can lead to a painful, flat foot. In about half of all cases, both feet are ...
What is the procedure to fuse bones together?
Fusion surgery: In cases in which excision would not be successful, such as where the tarsal coalition is too extensive, surgery may be performed to fuse the bones together. It may also be done when there is damage to the joints, when the patient is older, or if prior excision surgery was not successful.
Why do you need a CT scan for tarsal coalition?
A CT scan may be performed if x-rays don’t show the suspected source of the symptoms, or if an x-ray does not provide a good view of the tarsal coalition. CT scans may also used prior to surgery, in order to determine more accurately the location of the bone or tissue involved in the coalition.
Why does tarsal coalition occur?
Causes. Most often, tarsal coalition occurs during fetal development, resulting in the individual bones not forming properly. Less common causes of tarsal coalition include infection, arthritis or a previous injury to the area.
How to treat tarsal coalition?
The goal of nonsurgical treatment of tarsal coalition is to relieve the symptoms and to reduce the motion at the affected joint. One or more of the following options may be used, depending on the severity of the condition and the response to treatment: 1 Oral medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be helpful in reducing the pain and inflammation. 2 Physical therapy. Physical therapy may include massage, range-of-motion exercises and ultrasound therapy. 3 Steroid injections. An injection of cortisone into the affected joint reduces the inflammation and pain. Sometimes more than one injection is necessary. 4 Orthotic devices. Custom orthotic devices can be beneficial in distributing weight away from the joint, limiting motion at the joint and relieving pain. 5 Immobilization. Sometimes the foot is immobilized to give the affected area a rest. The foot is placed in a cast or cast boot, and crutches are used to avoid placing weight on the foot. 6 Injection of an anesthetic agent. Injection of an anesthetic into the leg may be used to relax spasms and is often performed prior to immobilization.
What is the goal of nonsurgical treatment of tarsal coalition?
The goal of nonsurgical treatment of tarsal coalition is to relieve the symptoms and to reduce the motion at the affected joint. One or more of the following options may be used, depending on the severity of the condition and the response to treatment: Oral medications.
What are the symptoms of tarsal coalition?
The symptoms of tarsal coalition may include one or more of the following: Pain (mild to severe) when walking or standing. Tired or fatigued legs. Muscle spasms in the leg, causing the foot to turn outward when walking. Flatfoot (in one or both feet)
Why is the foot immobilized?
Sometimes the foot is immobilized to give the affected area a rest. The foot is placed in a cast or cast boot, and crutches are used to avoid placing weight on the foot. Injection of an anesthetic agent. Injection of an anesthetic into the leg may be used to relax spasms and is often performed prior to immobilization.
How is tarsal coalition treated?
The treatment of tarsal coalition is decided upon the consideration of several factors. It is determined by assessing which bones have coalition, how extensive the coalition is, the severity of the symptoms and whether or not there are signs of degeneration of the bones and/or joints.
What bones make up the forefoot?
The phalanges and metatarsal bones and two sesimoid bones make up the forefoot (the toes and ball of the foot). The midfoot (around the arch of the foot) is made up of three cuneiform bones, the cuboid bone and the navicular bone. The talus (ankle) and calcaneus (heel) bones constitute the hindfoot.
How many bones are in the Tarsal Coalition?
The foot is made up of 28 bones. The 14 bones of the toes are called phalanges. The phalanges are jointed at the base of the toes where they connect to the five metatarsal bones.
How to treat tarsal coalition?
Rest, wearing orthotics such as arch supports, and taking NSAIDS (non-steroidal anti-inflammatory drugs), such as ibuprofen and naproxen, may be successful in reducing the pain. These therapeutic measures may mediate the symptoms of tarsal coalition, but they will not cure it.
What are the symptoms of tarsal coalition?
The symptoms of tarsal coalition are not specific to the condition. Sprains, strains, fractures, nerve damage and other conditions may also present with pain and stiffness.
Where is Tarsal Coalition found?
It is most commonly found between the calcaneus and navicular bones or the talus and calcaneus bones.
What does it mean when your foot is limping?
limping. decreased range of motion or immobility of the joints of the foot. The pain of tarsal coalition may be caused by strain on the ligaments, spasms of the muscles of the feet and the resultant shortening of foot tendons.
