Tarsal Coalition

Tarsal Coalition Treatment and Surgery, University Foot and Ankle Institute

Tarsal coalition, also known as rigid fixed-flatfoot, is a condition in which the foot is permanently fixed in a flat position. This can happen when two bones in the rear of the foot are fused together from birth, rendering the joints of the hindfoot and foot in general less mobile.


The physicians at University Foot and Ankle pride themselves in offering the best possible care for flat feet and tarsal coalition. 


While they often assist in the development of many surgical techniques and products, our specialists work hard to get you back on your feet and back to your life with the least invasive treatment possible.

What Causes Tarsal Coalition?

The bones in the back and mid-foot are called the tarsal bones. They include the heel bone, the talus, cuboid, navicular, and cuneiforms; they make up the collection of bones below the ankle, and before the toes (metatarsals). When performing their function properly, these bones coordinate to allow a normal range of motion for walking, running, holding one’s balance and accommodating uneven surfaces while walking.


When the tarsal bones abnormally grow together (often during fetal development), it is called tarsal coalition. Sometimes, individual bones can fail to articulate themselves properly while in the womb and a joint which should form in between the bones does not resulting in lack of normal motion in between those bones.


The abnormal growth can be comprised of cartilage, bone or fibrous scar tissue. Over time, these mechanical issues can cause a painful form of arthritis in the foot and ankle, lack of proper foot position and difficulty with normal walking.



Tarsal Coalition Symptoms

Although most people with fixed flatfoot are born with the condition, usually symptoms won’t manifest until the bones start to mature, around puberty (ages 9-15). Symptoms usually include:

  • Pain
  • Flatfoot
  • Limping
  • Stiffness and limited range of motion in the feet
  • Mild, moderate, or severe pain while standing or walking
  • Muscle spasms that force the foot out while walking
  • Muscle fatigue in the legs



Diagnosing Tarsal Coalition

Because symptoms are usually delayed until adolescence, tarsal coalition can be tricky to diagnose early on. If you or your child are experiencing symptoms of tarsal coalition, visit your foot and ankle specialist. Your doctor will conduct a thorough examination of your foot and observe your symptoms while standing and walking.


Your doctor may also order x-rays or other advanced imaging tools, such as MRI or CT scans, to identify the particular location of the coaltion.



Tarsal Coalition Treatment

It is important to consider that the longer the coalition is present, the more deformity there will be in the foot and the more deformed the bones will become. It is important to treat the coalition early to allow normal motion of the foot.


Treatments for tarsal coalition are usually aimed at minimizing pain and discomfort, reducing muscle spasms and fatigue, and restoring normal foot function. Not all fusions need to be treated and as long as the foot is not painful.


You and your foot and ankle specialist will decide the best course of action for treatment based on your age, the severity of your condition, and your everyday activities.


Non-surgical Treatments for Tarsal Coalition

Pain relievers. Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen can decrease pain and inflammation in the joints.

Physical therapy. A regimen of massage, ultrasound therapy, and exercises you can perform at home can reduce pain and improve your range of motion.

Steroids. Steroids can be injected into the area to reduce symptoms. Your condition may require repeated injections which is not recommended. Steroid injection is used sparingly only in cases of severe pain and only one or two times during a 10 year period.

Orthotics. An orthotic can be used to control foot motion and decrease pain and foot stress.



Restorative Treatments

For those patients whose symptoms aren’t responding to conservative treatments, another option that is less invasive than surgery is restorative medicine. These advanced therapeutic techniques promote natural healing in the body and can prevent further degeneration of the affected joints. It is important to consider that the foot will not change shape and will remain flat but the pain may resolve. They include:

Platelet-rich plasma therapy. In this procedure, blood is drawn from the patient and processed in a centrifuge that isolates the platelets. The platelets are then injected back into the damaged site, where they stimulate growth and encourage natural healing.

Amniotic stem cell therapy: This technique involves injecting donated stem cells into the posterior tibial tendon and the arch of the foot. The stem cells help to generate the body’s own growth factors that promote natural healing.

Bone marrow stem cell therapy: Bone marrow is comprised of hundreds of thousands of stem cells which are responsible for the healing of all different ailments in the body. A concentration of bone marrow cells can be used to attempt to head the tarsal coalition area and build cartilage in the area in order to decrease pain. It is important to consider that the coalition will not go away but the pain might.



Tarsal Coalition Surgery

Surgery is usually considered as a last resort option if non-invasive treatments fail to address the symptoms. Surgery usually involves correcting the flat foot position by removing the boney, cartilaginous, or fibrous bridge between the two bones that have grown together, or that had never completely divided naturally.


If the coalitions are severe and show significant signs of arthritis or deformity, a joint fusion of may be recommended. The goal of this procedure is to align the foot in a proper position and permanently fuse one or all of the rearfoot joints. Rearfoot fusion should be reserved for the most severe cases of tarsal coalition.

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