People typically don’t experience symptoms of a tarsal coalition until late childhood or early adulthood. Left untreated, it can result in stiff feet which restrict activity and cause pain.
MRI is the gold standard in diagnosing tarsal coalition, boasting intra- and interobserver reliability of 0.9038 and 0.9616 respectively. Furthermore, an MRI scan can reveal its anatomical type (TC or CN), depending on severity. Possible treatment options could include surgical removal or joint fusion.
Symptoms
Tarsal coalition is an abnormal connection that forms between one or more bones in the hindfoot (the back of the foot). This bridge may consist of bone, cartilage or fibrous tissue and affect the calcaneus (heel bone), talus, cuboid and navicular bones; typically this coalition limits their mobility while possibly leading to pain in either heel or arch areas. Most often caused by genetic mutations that disrupt prenatal bone development of these joints; infections, injuries or arthritis may also trigger this condition.
Most children diagnosed with tarsal coalition do not show symptoms until late childhood or early adolescence when their bones begin to harden through ossification – if left untreated this condition could result in severe flatfoot and become painful over time.
Your child’s doctor can diagnose tarsal coalition by gathering medical history and conducting a physical exam on their foot and ankle, checking for flatfoot, joint stiffness or pain, abnormal gait patterns or lack of movement in either foot or ankle, an abnormal gait pattern or limited foot/ankle mobility. They may order imaging studies such as X-rays, CT scans or an MRI to ascertain its extent. In many cases, treating pain due to tarsal coalition is sufficient treatment – unlike for more severe conditions like cancer where medical intervention may be required.
Diagnosis
The tarsal bones are located near the back of your foot and heel and work together harmoniously for proper foot function. When two or more of these bones form an abnormal connection – called a “tarsal coalition” – this may result in pain below your ankle and in the back of the heel, as well as stiffness below it. Although this condition often begins at birth, symptoms may not become evident until later childhood or adolescence when bones mature further and undergo increased stress.
X-rays can help your doctor pinpoint and assess the severity of a coalition, while CT and MRI scans may provide more detail as to its location and severity, as well as other structures within your leg and foot.
Treatment of tarsal coalition is determined by its severity and impact on daily activities for your child. Nonsurgical approaches may include arch supports and shoe inserts, restricting activity that leads to flare-ups of pain, wearing a boot or cast to limit movement, physical therapy with range-of-motion exercises, strength training exercises, massage techniques and stretching activities, among others.
Surgery may be recommended when nonsurgical methods fail to relieve severe, recurrent or chronic cases of tarsal coalition that do not respond well. Procedures will depend on the nature and location of your coalition; one such process is resection; this involves cutting away part of your coalition to replace it with muscle or fat from another part of your body. In severe or complex coalition cases involving arthritis however, joint fusion may be used as an option, using screws, staples and plates to restrict movement between bones while creating an ideal position for healing.
Treatment
Tarsal coalition refers to an abnormal connection or fusion between one or more bones located at the back of the foot (hindfoot and midfoot), most often between calcaneus (heel bone), talus (one of ankle bones) and navicular bones lining the inner side of ankle just forward of arch.
Tarsal coalitions may be present from birth, but usually become painful in late childhood or adolescence when they harden (ossify). Symptoms range from mild to severe but typically include pain, stiffness or limping.
Doctors can diagnose tarsal coalition by conducting a physical exam and reviewing your child’s complete medical history. He or she may order X-rays, which provide clear images of bones to show whether there is a coalition present, while computed tomography scans (CT/CAT scans) give more in-depth views and can help your doctor to assess coalition size more precisely. CT or CAT scans also allow for more in-depth images of bones to help determine size; magnetic resonance imaging (MRI) allows doctors to get even greater insights into organs within your child’s body, with this modality capable of detecting irregular bars formed of cartilage/fibrous tissue not visible by X-rays/CT scans alone.
Treatments for tarsal coalition are generally nonsurgical, including orthotics and physical therapy. If symptoms don’t respond to conservative treatments, surgery may be recommended to remove or separate the coalition and insert fat or muscle to keep them apart; in cases of large coalitions or extensive arthritis, however, joint fusion may also be used to limit movement of affected joints and decrease pain.
Prevention
As soon as a child is born, their tarsal bones should separate into individual joints. Unfortunately, for some individuals these bones form an abnormal connection — an unusual connection consisting of bone, cartilage or fibrous tissue — called a tarsal coalition. Coalitions typically develop prior to birth but do not manifest symptoms until late childhood or early adolescence – they can affect either foot; commonly seen types include Calcaneonavicular and Talocalcaneal coalitions.
Your child’s physician can diagnose tarsal coalition by performing a physical exam of his/her foot and ankle, including testing flexibility and how the foot rolls while walking. They may also order tests such as X-rays, computed tomography (CT) scans or magnetic resonance imaging (MRI).