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What is tarsal coalition?

Leana Huntley is an English trained foot health practitioner attached to ALMAWI Limited – The Holistic Clinic. Call 662-1732 for an appointment, or email lhuntley@almawiclinic.com Tuesday - Saturday. Check for the Clinic at www.almawiclinic.com.

By Foot Health with Leana

Tarsal coalition is a fusion or sticking together of the tarsal bones in the foot. The tarsals are seven bones located at the back of the foot. Tarsal coalition is a congenital disease, meaning you are born with it.

Symptoms
The symptoms include pain in the midfoot area in adolescents, which is usually felt after activities, or hard training for those involved in sports. Sometimes the condition becomes obvious after an ankle sprain, when the pain does not appear to get any better. Other signs include the arch of the foot collapsing, with reduced movement at the ankle joint. In the case of an athlete, they may walk with a limp, complaining of stiffness in the foot and ankle.
Symptoms usually do not appear until the bones have started to mature, between the ages of nine and 16. However, some people will not display any symptoms until later on in life, possibly if they start to exercise or suffer an ankle sprain.
The athlete may complain of symptoms of tarsal tunnel syndrome which can be caused by an unknown tarsal coalition.
The symptoms of the condition may include one or more of the following:
• Pain (mild to severe) when walking or standing
• Tired or fatigued legs
• Muscle spasms in the leg, causing the foot to turn outward when walking
• Flatfoot (in one or both feet)
• Walking with a limp
• Stiffness of the foot and ankle

Causes
Most often, tarsal coalition occurs during foetal development, resulting in the individual bones not forming properly. Less common causes of tarsal coalition include infection, arthritis, or a previous injury to the area.
It usually affects adolescents as the fibrous or cartilaginous joints between the bones ossify (turn to bone) and harden. This causes a decreased range of motion in the rear foot causing strain on the ankle joint. Tarsal coalition can occasionally develop in later life due to an infection or arthritis in the joints, or an ankle injury.

Diagnosis
A tarsal coalition is difficult to identify until a child’s bones begin to mature. It is sometimes not discovered until adulthood. Diagnosis includes obtaining information about the duration and development of the symptoms, as well as a thorough examination of the foot and ankle. The findings of this examination will differ according to the severity and location of the coalition.
In addition to examining the foot, the surgeon will order X-rays. Advanced imaging studies, MRI, may also be required to fully evaluate the condition. An X-ray may show up an osseous coalition and an MRI may show up a fibrous one.

Treatment
Non-surgical Treatment
The goal of non-surgical treatment of tarsal coalition is to relieve the symptoms and reduce the motion at the affected joint. One or more of the following options may be used, depending on the severity of the condition and the response to treatment:
• Oral medications - Non-steroidal anti-inflammatory drugs may be helpful in reducing the pain and inflammation.
• Physical therapy - This may include massage, range-of-motion exercises, and ultrasound therapy.
• Steroid injections - An injection of cortisone into the affected joint reduces the inflammation and pain. Sometimes more than one injection is necessary.
• Orthotics — Orthotic devices or arch supports can be beneficial in distributing weight away from the joint, while limiting motion at the joint and relieving pain.
• Immobilisation -Sometimes the foot is immobilised to give the affected area a rest. The foot is placed in a cast or air cast boot, and crutches are used to avoid placing weight on the foot.

When is Surgery Needed?
If conservative treatment fails, surgery is an option. The orthopaedic surgeon will determine the best surgical approach based on the patient’s age, condition, arthritic changes, and activity level.Surgery may be used to either excise or remove the excess bone growth, or to completely fuse the two joints together.

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