Tarsal coalitions

What it is:

Tarsal coalition is a condition where two or more bones in the foot (called tarsal bones) are abnormally connected. This connection can be made of bone, cartilage, or fibrous tissue, limiting movement and flexibility in the affected part of the foot. It often leads to stiffness and pain, particularly in the back part of the foot (hindfoot).

What causes it:

Tarsal coalition is usually a congenital condition, meaning children are born with it. It occurs during foetal development when the tarsal bones do not separate properly. In some cases, it may be linked to genetic factors, as it can run in families. Less commonly, it can result from injuries, infections, or arthritis.

Different types:

Yes, there are several types, depending on which bones are connected:

• Calcaneonavicular Coalition: The most common type, where the calcaneus (heel bone) and the navicular bone are joined.
• Talocalcaneal Coalition: Involves a connection between the talus (ankle bone) and the calcaneus (heel bone).
• Other Rare Types: Less commonly, other tarsal bones can be involved, but these are rare.

Symptoms:

Symptoms usually appear between ages 9 and 16 as the bones harden. They may include:

• Pain in the foot, especially after physical activity.
• Stiffness and difficulty moving the foot.
• Frequent ankle sprains.
• Flatfoot or a rigid flatfoot that doesn’t flex normally.
• Walking with a limp or an awkward gait.

Possible complications:

If untreated, tarsal coalition can lead to:

• Chronic pain.
• Recurrent ankle sprains due to poor foot mobility.
• Arthritis in the foot or ankle joints over time.
• Difficulty in participating in physical activities or sports.

How it can be diagnosed:

Diagnosis involves:

• Physical Examination: A doctor checks for foot stiffness, pain, and flatfoot.
• Imaging Tests: X-rays are often the first step. CT scans or MRIs provide more detailed images to confirm the diagnosis and assess the extent of the coalition.

Treatment options:

Non-surgical options:

• Rest and Activity Modification: Limiting activities that cause pain.
• Orthotics: Custom shoe inserts to support the foot and improve alignment.
• Physical Therapy: Exercises to strengthen muscles and improve flexibility.
• Medications: Anti-inflammatory drugs to reduce pain and swelling.
• Casting or Bracing: To immobilize the foot temporarily and relieve pain.

Surgical options:

If non-surgical treatments don’t relieve symptoms, surgery may be recommended:

• Resection: Removal of the abnormal connection between the bones. This is common for younger children with less severe coalitions.
• Fusion: In severe cases, the affected bones are fused together to relieve pain, though this limits movement.

Recovery:

• Non-surgical Treatment: Recovery varies but usually involves weeks to months of rest and gradual return to activity.
• Surgical Treatment: Recovery can take several months. Physical therapy is often needed to restore strength and mobility. Children may need crutches or a cast during the initial healing phase.

How it can be prevented:

Tarsal coalition is typically a congenital condition, so it cannot be prevented. However, early diagnosis and treatment can prevent complications such as chronic pain or arthritis. Ensuring children wear supportive footwear and avoiding repetitive foot injuries can also help manage symptoms.

Frequently Asked Questions

Q: Will my child outgrow tarsal coalition?
A: No, tarsal coalition does not go away on its own but symptoms may improve with non-surgical treatment.

Q: Can my child play sports?
A: Yes, but it depends on the severity of the condition. Non-contact, low-impact sports are usually better tolerated. A healthcare provider can advise on activity limitations.

Q: Will my child need surgery?
A: Not always. Many children manage well with non-surgical treatments. Surgery is considered if pain persists or worsens despite other treatments.

Q: Is tarsal coalition hereditary?
A: Yes, it can run in families, but not all family members will necessarily have symptoms.

Q: Will my child have long-term problems?
A: With appropriate treatment, most children lead active lives without significant limitations. However, severe cases may lead to arthritis or chronic pai