One of the less common causes of flatfoot and foot pain we see at Kansas City Foot and Ankle are tarsal coalitions. A tarsal coalition is where there is a failure of the bones of the foot to fully separate during development, leading to congenital connections between the bones in the back of the foot, also known as the “tarsal bones.” The talus, the navicular, and the calcaneus are the tarsal bones and a tarsal coalition is an abnormal connection between two or more of these bones. Most commonly, patients experience pain with tarsal coalitions during adolescence or early adulthood. Generally, the pain is worsened by activity and relieved with rest and anti-inflammatory medications. Patients may notice the pain more on uneven surfaces, as the joints in the back of the foot are largely responsible for adapting to uneven surfaces and will not be able to adjust in these circumstances, resulting in pain.
Many times, tarsal coalitions can be asymptomatic, but patients can experience the following:
- Pain, particularly with activity
- Difficulty walking on uneven surfaces
- A rigid flatfoot deformity, particularly if only one foot is flat and the other has a higher arch, although the condition can occur in both feet
An x-ray is usually needed to diagnose a tarsal coalition and often advanced imaging modalities such as an MRI or CT scan are used to fully diagnose the coalition if x-rays are not definitive. An MRI can be helpful in diagnosing fibrous or “non-bony” tarsal coalitions that can be missed on routine x-ray and CT scans tend to provide excellent views of coalitions as well.
Tarsal Coalitions may be treated non-surgically or surgically depending on the severity of the symptoms.
Generally, non-operative treatment involves:
- making proper shoe selections
- custom molded orthotic inserts
- Anti-inflammatory medications
- Steroid injection into the affected joint
- Activity modification and avoidance of uneven surfaces
Surgical treatment of Tarsal coalitions involves either trying to remove the abnormal connection between the fused bones to improve motion or by fusing the bones permanently to eliminate the pain between them. Both methods have advantages and disadvantages and should be discussed with your foot and ankle surgeon. Fortunately, surgical intervention is not often needed to treat tarsal coalitions in most patients, as many patients respond favorably to non-surgical care.
If you think you or someone you know may have a tarsal coalition call 816-943-1111 today to schedule an appointment with the Foot and Ankle experts at Kansas City Foot and Ankle for a full evaluation.