Condition Spotlight: Tarsal Coalition

What is a Tarsal Coalition?

A tarsal coalition is a condition where there is an abnormal connection or fusion between 2 bones in the midfoot and the rearfoot.

This fusion can be caused by bone and cartilage of fibrous tissues and is often referred to as a bar.

A tarsal coalition results in a restriction of movement and can be painful. It can also cause other problems through the ankle and the knee.

Coalitions generally occur between the bones towards the back of the heel including the talus, navicular and the calcaneus (heel bone).

Tarsal coalitions can include:

  • Talo-calcaneal
  • Calcaneo-navicular
  • Calcaneo-cuboid
  • Talo- navicular

What Causes a Tarsal Coalition?

Often, a tarsal coalition occurs during foetal development whereby the bones do not form properly.

This type of tarsal coalition can have a genetic component to it, meaning that it is passed down through the generations.

However, it can sometimes occur due to arthritis, infection, surgery or traumatic injury which can distort the position of the bone or cause it to heal into another bone.

What Does a Tarsal Coalition Feel Like?

Patients with a tarsal coalition generally experience pain and/or discomfort predominantly in the feet and ankles, however this can extend up to the knees and legs.

Often, they will state that they feel that the joints in their feet are ‘locked up’ or that their feet don’t seem to be able to move properly.

Fatigue through the feet and ankles, as well as stiffness of the joints can also be experienced.

Those who are born with a tarsal coalition usually do not develop any symptoms until their bones are fully formed and fused, around the early to mid teenage years.

Sometimes tarsal coalitions can lead to spasms within the muscles of the foot as they try to compensate for this abnormality.

Some research suggests that up to 75% of tarsal coalitions are asymptomatic, meaning that the person does not feel any pain.

Those with a tarsal coalition are also more likely to experience eversion ankle sprains due to the foot posture.

How is a Tarsal Coalition Diagnosed?

A tarsal coalition can be suspected using various testing methods and history taking in the clinic.

This will include discussing what symptoms are present and how long they have been there, palpation of the painful structures, range of motion testing and gait assessments.

Generally, there will be a reduced range of motion through the affected joints and the foot will be flatter through the arch.

However, a tarsal coalition can only be formally diagnosed using an X-ray, MRI or CT scan.

How is a Tarsal Coalition Treated?

There are various ways a tarsal coalition may be treated or managed, including:

Immobilisation of the foot and ankle (in early intervention in children)

This is to attempt to avoid the formation of a coalition before the bones have ossified or fully formed. This is only applicable to tarsal coalitions that are detected in early childhood.

A stretching and strengthening program for the surrounding structures

This will help to reduce tension of the surrounding structures, whilst also improving the strength of these structures to allow them to function more effectively.

Orthotic therapy

Orthotics can help assist the foot in functioning more efficiently by offloading certain areas and supporting the structures of the foot.

At the clinic we have both prefabricated orthotics and custom orthotics.

For those with a tarsal coalition, custom orthotics typically provide more support and correction and are therefore the preferred option to assist with pain and function.

Mobilisation and manipulation

This includes trying to improve the range of motion of the joints within the foot.

If the tarsal coalition is soft tissue in nature (cartilage), this may prove very effective.

If the tarsal coalition involves bony tissue, this may not yield the same benefits but may help to reduce pain in the surrounding structures.

Footwear modifications and advice

Wearing proper footwear to cater for your foot type is extremely important. Whilst it won’t change the tarsal coalition, the right shoes will provide you with the support and comfort you need to keep you moving.

Wearing shoes that are inappropriate for your foot type can increase pain significantly.

Surgery

Surgery is the best option once the bones have fully formed/ossified or if you are beginning to experience significant pain.

Surgical options will depend on the degree of the coalition, where it is situated and whether it is bony or soft tissue in nature.

We are able to refer you to a number of podiatric and orthopaedic surgeons to discuss if this is the best option for you.

Visit us at Watsonia Podiatry Clinic

If you’re experiencing symptoms like those we’ve described today, or your feet or lower limbs are in pain, book in to see one of our podiatrists today.

We can assess, diagnose and treat all sorts of conditions that may be affecting your feet and body.

Book an appointment online here or call us on 03 9432 2689.

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