Impact of a Tarsal Coalition

A tarsal coalition is a condition of the foot where two or more bones are connected together in an abnormal fashion. The bones involved are the tarsal bones which are a group of bones located between the ankle and the midfoot. This condition can affect any age but is more noticeable in children as they grow. The condition is found in about 1 in 1000 people making it a relatively rare condition but one that is worth being aware of (Docquier et al., 2019; Mehdi et al., 2024).

Most causes of tarsal coalition are congenital, or present at birth. Often tarsal bones do not completely separate during fetal development. Abnormal connections between tarsal bones restrict motion and can produce pain. The coalition most often involves the calcaneus and the navicular bone (Calcaneonavicular bar), or the talus and calcaneus (Talocalcaneonavicular bar). Although less common, tarsal coalition can also occur due to injury or trauma where, over time, the bones fuse together.

The symptoms of tarsal coalition can vary greatly from person to person. Some people do not experience any symptoms at all. Others may have pain in their foot or ankle during physical activities. Runners, jumpers, and even people who like to play sports can experience pain in their foot. The symptoms can be constant or intermittent. The pain can be sharp or dull and aching. Sometimes people feel stiffness in their feet and even swelling. In severe cases, people can have difficulty walking or even standing. Many people with tarsal coalition have limited mobility in their foot and this can create problems with activities of daily living. For example, many people are unable to participate in sports that they used to enjoy. Some people are even unable to participate in activities with their family and friends. Some people have even reported feeling left out of activities with their family and friends. This can create a feeling of isolation and can be very frustrating for people with tarsal coalition.

Conversely, tarsal coalitions can bring many complications. The primary complication is the effect the tarsal coalition has on the mobility of an individual. If an individual with a tarsal coalition participates in activities that require them to be on their feet for long periods of time, it can create extreme amounts of pain and weariness. It can also leave an individual feeling frustrated because they feel as though they are missing out on activities that their peers are able to participate in. This can be a huge emotional struggle for some people. The pain and stiffness felt by individuals with tarsal coalitions can cause some to become isolated. This is because the conditions can make it difficult for individuals to complete everyday tasks that require mobility, such as participating in sports. This can cause individuals with tarsal coalitions to feel as though they are missing out on things to do with their family and friends, and can cause feelings of frustration, depression, and low self-esteem. Overall, tarsal (or fused) bones in the foot of an individual can be a very frustrating condition.

Understanding how Tarsal Coalition can affect a person’s mobility and subsequently their life is key to providing the necessary care and support to individuals with this condition. The causes and symptoms of Tarsal Coalition have been detailed above, with pain in the foot or ankle and a limited range of motion in the foot the two most common symptoms. These symptoms can cause individuals with this condition a lot of problems as they try to carry out everyday activities. For example, individuals with this condition may find it difficult to participate in sports, such as running or jumping, due to the amount of pain that they are in and the lack of mobility in their foot. Furthermore, individuals with this condition may find that they are unable to carry out other physical activities, which can leave them feeling extremely frustrated and with a decreased quality of life.

Proper diagnosis of a tarsal coalition is critical in order to treat it accordingly. The first form of diagnosis is radiographic images, typically X-rays. These are the standard test to view the bones of the foot and to check for any fusions between the tarsal bones. However, as was previously stated, X-rays are not always clear. A CT scan is usually recommended to gain further images of the bones and soft tissues in the foot. The CT scan is also better to clearly visualize tarsal coalitions. Another form of imaging that is often used to diagnosis tarsal coalitions is MRI’s or Magnetic Resonance Imaging. MRI’s are often used to clearly view soft tissues in the body, and in the case of tarsal coalitions it can show if there is any damage to the surrounding muscles and ligaments (Lawrence et al., 2014).

Treating tarsal coalition typically involves two types of methods, nonoperative and surgical, and both have the goal of lessening pain, reducing symptoms, and to increase mobility of the joints of the foot, which have been affected by tarsal coalition. Conservative treatment for tarsal coalition is the most common form of treatment. A physical therapy program and the use of medications, usually nonsteroidal anti-inflammatory drugs, are two common nonoperative methods to treat tarsal coalition (Kothari & Masquijo, 2020; Addar et al., 2021).

Surgical intervention of tarsal coalitions is usually necessary when nonoperative methods of pain management are ineffective. The vast array of surgical approaches to address tarsal coalitions can be generally categorized into resection of the coalition. The surgical approach can vary significantly based on the type of coalition, patient’s age, as well as overall patient health. For most patients with severe pain or restricted mobility, surgery is the only option that can help to alleviate their symptoms and return to normal activity (Kothari & Masquijo, 2020; Addar et al., 2021).

The results from both nonoperative and surgical treatment for tarsal coalition can vary to a great extent. However, most of the cases reported in the literature were relieved of their symptoms using nonoperative methods. Patients who underwent surgery reported relief from pain and were able to return to their activities and sports. They were also able to return to work and other daily activities. In some cases, results from surgery were reported to be very successful. In these cases, patients were able to return to sports and other activities that they previously had to avoid because of pain from their tarsal coalition (Shirley et al., 2018; Chytas et al., 2016).

From their physical limitations to the psychological strain of being unable to participate in social functions due to chronic pain, Tarsal Coalition can have very far-reaching effects. Individuals and their families often are affected in very positive ways by treatment of this foot condition. Many people are able to participate again in sports and in functions with their families and friends that they were unable to do prior to surgery. People with Tarsal Coalition and their families report feelings of increased self-esteem, and a reduction in symptoms of anxiety and/or depression after treatment of this foot condition (Vosoughi et al., 2025).

By taking steps to manage and/or treat tarsal coalition effectively, you can come to terms with this and improve the quality of your life. The steps that you take may be of a nonoperative nature, or surgery could be indicated; either way, relief of pain, and increase in mobility, are important components of any treatment and have far-reaching effects upon all aspects of a patient’s life.

Citations:

Mehdi, N., Bernasconi, A. and Lintz, F., 2024. Tarsal coalition in adults. Orthopaedics & Traumatology: Surgery & Research, 110(1), p.103761. https://www.sciencedirect.com/science/article/pii/S1877056823003092

Docquier, P.L., Maldaque, P. and Bouchard, M., 2019. Tarsal coalition in paediatric patients. Orthopaedics & Traumatology: Surgery & Research, 105(1), pp.S123-S131. https://www.sciencedirect.com/science/article/pii/S1877056818300951

Soni, J.F., Valenza, W. and Matsunaga, C., 2020. Tarsal coalition. Current Opinion in Pediatrics, 32(1), pp.93-99. https://journals.lww.com/co-pediatrics/fulltext/2020/02000/tarsal_coalition.13.aspx

Chytas, A., Chaudhry, S. and Alshryda, S., 2016. Evidence-based treatment for tarsal coalition. In Paediatric Orthopaedics: An Evidence-Based Approach to Clinical Questions (pp. 175-182). Cham: Springer International Publishing. https://link.springer.com/chapter/10.1007/978-3-319-41142-2_20

Zhou, B., Tang, K. and Hardy, M., 2014. Talocalcaneal coalition combined with flatfoot in children: diagnosis and treatment: a review. Journal of orthopaedic surgery and research, 9(1), p.129. https://link.springer.com/article/10.1186/s13018-014-0129-9

Vosoughi, A.R., Matz, J. and Rammelt, S., 2025. Associated coalitions of tarsal bones: review of the literature and presentation of a classification. JAAOS-Journal of the American Academy of Orthopaedic Surgeons, 33(16), pp.908-915. https://journals.lww.com/jaaos/fulltext/2025/08150/associated_coalitions_of_tarsal_bones__review_of.4.aspx

Lawrence, D.A., Rolen, M.F., Haims, A.H., Zayour, Z. and Moukaddam, H.A., 2014. Tarsal coalitions: radiographic, CT, and MR imaging findings. HSS Journal®, 10(2), pp.153-166. https://journals.sagepub.com/doi/abs/10.1007/s11420-013-9379-z

Kothari, A. and Masquijo, J., 2020. Surgical treatment of tarsal coalitions in children and adolescents. EFORT open reviews, 5(2), pp.80-89. https://eor.bioscientifica.com/view/journals/eor/5/2/2058-5241.5.180106.xml

Addar, A., Marwan, Y., Algarni, N., Algarni, N., Berry, G.K. and Benaroch, T., 2021. Tarsal coalition: Systematic review of arthroscopic management. The Foot, 49, p.101864. https://www.sciencedirect.com/science/article/pii/S0958259221000900

Shirley, E., Gheorghe, R. and Neal, K.M., 2018. Results of nonoperative treatment for symptomatic tarsal coalitions. Cureus, 10(7), p.e2944. https://www.cureus.com/articles/9727