Tarsal Coalition

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. In the past this condition has been called peroneal spastic flatfoot. Tarsal Coalitions are not uncommon, affecting approximately 1-2% of the population.

The tarsals are the group of bones that make up the rear foot and mid foot. These include the talus, calcaneus, navicular, cuboid and cuneiform bones.

The two most common types of coalitions are the calcaneonavicular coalition and the talocalcaneal coalition.


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.

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 are disrupted.

The primary symptom that patients present with is PAIN. Usually the pain is located just below the fibula (bone on the outside of the ankle). As the child ages, and the condition becomes more advanced pain may be noticed in other areas. For example; pain on the top of the foot, pain on the outside of the foot, knee pain and/or back pain. Pain can present in the knee and back as a result of altered gait patterns.

How do we diagnose a Tarsal Coalition?

It is quite common for patients to begin to experience symptoms between the ages of 8 – 15 as a result of changes occurring in the foot during growth and development.
A thorough biomechanical assessment involving; History taking, joint range of motion assessments, muscle range of motion assessments, visual and digital gait analysis are all used to help determine the presence of a Tarsal Coalition.
Xray, CT and MRI imaging are excellent for confirming the presence of this condition.

tarsal coalition xray

x-ray film identifying tarsal coalition

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
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.

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

Non-Surgical Treatments
– Orthotic therapy
– Soft tissue therapy
– Exercise therapies
– Proprioception/Balance exercises

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