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What Is A Tarsal Coalition?

tarsal coalition

A Tarsal Coalition is a congenital condition which affects the bones of the foot in both children and adolescents. This issue can occur when the bones of the feet fail to separate during foetal development and may cause a stiff, flat foot. The condition is not common, but it is not rare. About one in a hundred people, 1% of the population, have a tarsal coalition.


The tarsal bones are the seven bones that make up the heel and the midfoot. The metatarsals and the phalanges are connected to the tarsals and form the forefoot. A tarsal coalition can affect any of the tarsal bones; all but two types of tarsal coalitions are extremely rare.

The coalition between the two bones can be made of bone, cartilage, or fibrous tissue. This abnormal connection may lead to limited motion and pain in one or both feet.


Most often, tarsal coalition occurs during foetal 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

Tarsal coalition is genetic, meaning that it runs in families. Tarsal coalitions can become a problem because it can seriously affect the way the bones of the foot move as we walk. To function correctly, all of the bones of the foot must move in relationship to each other. If the movement between two bones is abnormal or non-existent, the motion in other joints is disrupted. The abnormal motion increases the stress on other joints. Over time, this leads to wear and tear on those joints and finally, it leads to pain.


While many people who have a tarsal coalition are born with this condition, the symptoms generally don’t begin to manifest themselves until the bones begin to mature, usually around ages 9-16 as the individual begins to go through puberty. Sometimes the patient can be completely without any kind of symptoms during childhood but pain and symptoms may develop later in life.

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)
  • Walking with a limp
  • Stiffness of the foot and ankle

The primary symptom caused by a tarsal coalition is pain usually located on the outside of the foot just below the fibula. The fibula is the large bump on the outside of the ankle. This painful area is called the sinus tarsi.

When the condition becomes more advanced, other joints can be affected and pain may be felt on the top of the foot and on the outside of the foot.


How do we identify the problem?

The history and physical examination help to make the diagnosis of tarsal coalition. Your podiatrist will need information about the age and activity level of the child and will watch the child walk and move during gait. Finally, examination of the feet is necessary to locate areas of tenderness and look for restriction of motion in each of the joints in the foot.

In addition to examining the foot, your podiatrist will order x-rays. Advanced imaging studies may also be required to fully evaluate the condition.

What treatment options are available?

Non-surgical Treatment

The goal of non-surgical treatment is to relieve the symptoms and 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. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be helpful in reducing the pain and inflammation.
  • Steroid injections. An injection of cortisone into the affected joint reduces the inflammation and pain. Sometimes more than one injection is necessary.
  • Orthotic devices. Custom orthotic devices can be beneficial in distributing weight away from the joint, limiting motion at the joint and relieving pain.
  • 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.

When is Surgery Needed?

When the condition continues to be painful despite non-surgical treatment, your podiatrist may recommend surgery. Surgery for tarsal coalition falls into two categories: 1) surgery to remove or excise the additional bone and attempt to restore normal motion between the two bones or 2) surgery to fuse the affected joints together solidly.

The foot and ankle surgeon will determine the best surgical approach based the patient’s age, condition, arthritic changes, and activity level.

As a general rule, excision is more likely to be successful in the younger child. In the older child or adolescent, a fusion may be required. Once the surrounding joints have become excessively worn, or degenerative, restoring motion may not be enough to stop the pain. The older the patient, the more likely this has occurred.

If any of these symptoms are familiar to you then it’s a good idea to get yourself, or your child checked out and assessed thoroughly to determine what, if any, treatment options are best suited to get you back on your feet.

Thanks for reading,



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Sutherland, NSW 2232

Tel: 02 9542 3491