What is Tarsal Coalition?
A tarsal coalition is a condition involving an abnormal union between two of the tarsal bones located in the rear part of the foot. The irregular connection could be bony, cartilaginous, or fibrous, leading to diminished foot movement and pain on one or both feet.
The tarsal bones involved include the calcaneus (heel bone), talus, navicular, cuboid, and cuneiform bones. Together, they enable the foot to function normally.
Tarsal coalitions are primarily formed during fetal development, leading to improper bone formation. It can occasionally result from infection, arthritis, or past injuries in the area.
Symptoms to Watch For
Generally congenital, a tarsal coalition’s symptoms often appear during bone maturation, roughly between the ages of 9 and 16. Symptoms might not manifest in childhood but can arise later. They include:
- Varying pain levels during standing or walking
- Leg fatigue or tiredness
- Leg muscle spasms, causing outward foot turning
- Presence of flat feet
- Limping when walking
- Stiffness in the foot and ankle
Diagnosing the Coalition
Diagnosing a tarsal coalition is challenging before bone maturation. It may even go unnoticed until adulthood. The assessment involves understanding symptom history and conducting a detailed foot and ankle exam. The exam findings vary based on the coalition’s severity and location.
The surgeon will perform an X-ray and may request advanced imaging tests for thorough evaluation.
Non-Surgical Treatment Approaches
Non-surgical management aims to alleviate symptoms and minimize motion at the coalition. Treatment might involve:
- Oral Medications: NSAIDs like ibuprofen help reduce pain and inflammation.
- Physical Therapy: Includes massage, exercises, and ultrasound therapy.
- Steroid Injections: Cortisone shots lessen inflammation and pain, potentially needing multiple doses.
- Orthotic Devices: Custom-made devices redistribute weight, limit joint motion, and relieve discomfort.
- Immobilization: To rest the area, a cast or boot immobilizes the foot, accompanied by crutches to avoid weight.
- Anesthetic Agent Injection: To reduce spasms, anesthetics are sometimes used before immobilization.
When Is Surgery Needed?
When symptoms persist despite non-surgical treatments, surgery may be necessary. The type of surgery will be tailored to the patient based on age, specific condition, existing arthritic changes, and activity levels.