Tarsal Coalition

A tarsal coalition is unusual yet common cause of foot pain in children & adolescents.

Not all patients who have a tarsal coalition will experience any pain or adverse effects and may go their entire lives without a problem. For others a tarsal coalition has the potential to create a lifetime of problems, including pain, disability & the development of arthritis. 

What is a Tarsal Coalition?

A tarsal coalition is a congenital condition (present at birth) that affects the bones of the foot in children and adolescents. A tarsal coalition occurs when the bones in the feet fail to separate during fetal development.
Due to the changes in connective tissue structures surrounding the area the condition may also be referred to as peroneal spastic flatfoot.

Tarsal Coalitions are not uncommon, affecting approximately 1-2% of the population.

The foot is a very complex structure involving 26 bones (28 including the sesamoids) and over 30 joints. All of the bones/joints must move in relation to each other to function correctly.
If movement at a joint is abnormal or non-existent the entire foot and lower limb mechanics can be disrupted.

The tarsals are the group of bones that make up the rear foot and mid foot.
A coalition between the two bones can be made of bone, cartilage or fibrous tissue.
A coalition involving bone results in a stiff coalition, whereas a fibrous coalition has more flexibility.

image sourced from: http://teachmeanatomy.info


How do we diagnose a Tarsal Coalition?

It is quite common for patients to begin experiencing symptoms between the ages of 8–15 as a result of changes occurring in the foot during growth and development.

A thorough Biomechanical Assessment is performed to help determine the presence of a tarsal coalition, the physical impacts that are occurring and the individual treatment plan required to achieve the patient’s treatment goals.

Diagnostic Imaging of Tarsal Coalitions

X-Ray, CT and MRI imaging are excellent for confirming the presence of this condition and may assist in treatment planning.

Below are 3 of the common signs of a coalition involving the talocalcaneal joint (subtalar joint).

  1. Talar beaking
    Occurs due to limited motion of the subtalar joint resulting in increased force being applied at the talonavicular joint
  2. C-sign
  3. Loss of subtalar joint clarity

Subtalar Joint Coaltion

Consent was given from both patient & parent for using their xray image for this post.

Subtalar joint coalition of 16 year old male

Normal Subtalar Joint

Normal subtalar joint

The above xray was from a teenage patient who presented to our clinic in 2015.
This patient presented to the clinic with chronic hind foot pain that was limiting his ability to participate in his sporting activities. He had previously been prescribed multiple custom foot orthoses from a number of practitioners from a young age, which were having minimal impact on his pain.
Within minutes of our assessment we were suspicious of a tarsal coalition and referred for xray imaging confirming our diagnosis.

In this particular case surgical intervention was required. After surgical intervention our patient undertook a thorough rehabilitation program and was back to playing competitive Rugby League pain free.

Common Tarsal Coalitions

imaged sourced from http://bunionsurgeryny.com


imaged sourced from http://bunionsurgeryny.com


When to seek treatment?

  • Your child complains of PAIN
  • Noticing a change in your child’s gait (walking with a limp etc…)
  • Interfering with walking/activities
  • Difficulty fitting shoes
  • Swelling
  • Noticing a change in the appearance of the foot


Non-surgical and surgical treatment options are available. The treatment approach varies from patient to patient.

Non-Surgical Treatments

  • Orthotic therapy
  • Soft tissue therapy
  • Exercise therapies (including; strengthening, mobility & proprioceptive/balance exercises)
  • Footwear changes/advice
  • Cortisone

Surgical Treatments

Podiatric and Orthopaedic surgeons will assess each patient individually and treatment will vary on a case-by-case basis.

All treatments are implemented on a case-by-case basis, depending on the results of an individual’s Biomechanical Assessment and their treatment goals & requirements.

To book your child’s Biomechanical Assessment online click here

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