Tarsal Coalition

January 29, 2024

Pedsortho.com Staff

Talocalcaneal Coalition

Talocalcaneal coalition is a specific type of tarsal coalition that involves an abnormal connection between the talus and calcaneus bones in the foot. This condition is one of the most common types of tarsal coalitions. It can lead to restricted movement of the subtalar joint, which is responsible for allowing the foot to move inwards (inversion) and outwards (eversion). Talocalcaneal coalition typically manifests during childhood or adolescence, often becoming symptomatic during periods of rapid growth.

Symptoms

Symptoms of talocalcaneal coalition may vary but often include:

Pain in the foot, particularly with activity or after prolonged standing or walking.
Stiffness and limited movement in the ankle and foot.
Flatfoot, more commonly in one foot than both.
Muscle spasms in the foot or leg, which may lead to an awkward gait or limp.
Swelling and tenderness in the area of the coalition.

Causes

The exact cause of talocalcaneal coalition is not fully understood, but it is believed to be primarily congenital, meaning individuals are born with this condition. It results from incomplete separation of the talus and calcaneus bones during fetal development. There is also a genetic component, as the condition can run in families.

Diagnosis

Diagnosing talocalcaneal coalition often involves a thorough physical examination and imaging studies. X-rays can provide initial insights, but the coalition may not always be visible on standard X-rays due to its location. CT scans are more effective for diagnosing talocalcaneal coalition as they can provide detailed cross-sectional images of the bones and joints. MRI scans are also useful, especially for visualizing the cartilaginous connections that might not be evident on X-rays or CT scans.

Treatment

The treatment for talocalcaneal coalition focuses on relieving symptoms and improving foot function. Treatment options include:

Non-surgical treatments: These may involve rest, ice, anti-inflammatory medications to reduce pain and swelling, orthotic devices to support the foot and relieve pressure on the coalition, and physical therapy to improve flexibility and strength.
Surgical treatments: Surgery may be considered if non-surgical treatments fail to relieve symptoms. The specific surgical approach depends on the extent of the coalition and the patient's symptoms but can include resection of the coalition to restore motion to the subtalar joint or fusion of the affected joints to reduce pain (at the expense of motion).

The goal of treatment is to reduce pain and improve the function of the foot. The prognosis for individuals with talocalcaneal coalition varies, depending on the severity of the coalition, the effectiveness of treatment, and the presence of any associated foot deformities.

Calcaneonavicular Coalition

Calcaneonavicular coalition is a specific type of tarsal coalition involving an abnormal connection between the calcaneus (heel bone) and the navicular bone in the foot. This condition is congenital, meaning it is present at birth, and results from the failure of these two bones to separate during fetal development. It is one of the most common types of tarsal coalition.

Symptoms

Many individuals with calcaneonavicular coalition may not experience symptoms until late childhood or adolescence, when the bones begin to mature and physical activity levels increase. Symptoms can include:

Pain along the inside of the foot, especially with activity
Muscle spasms in the leg, causing an awkward walk or limp
Stiffness and limited motion in the foot
Flatfoot, particularly noticeable on one side
Recurrent ankle sprains or feelings of ankle instability

Diagnosis

Diagnosis of calcaneonavicular coalition can be challenging and often requires imaging studies. While X-rays can sometimes reveal the coalition, CT scans and MRI are more effective in providing detailed images of the bone and soft tissue structures, respectively, and can confirm the diagnosis.

Treatment

Treatment for calcaneonavicular coalition depends on the severity of symptoms and may include:

Non-surgical treatments: Initial approaches often involve rest, ice, anti-inflammatory medications to reduce pain and swelling, and physical therapy to strengthen surrounding muscles and improve foot function. Orthotic devices or supportive shoes may also be recommended to alleviate symptoms and support the foot.
Surgical treatments: Surgery may be considered for individuals who do not respond to conservative treatments and continue to experience significant pain or mobility issues. Surgical options typically involve resection of the abnormal bone connection to allow for more normal motion between the affected bones. In some cases, if the coalition is extensive or if resection is not viable, a fusion of the affected bones may be considered to alleviate pain, although this will limit motion in the affected joint.

The goal of treatment is to relieve pain and restore as much function as possible. Many individuals with calcaneonavicular coalition are able to return to their regular activities with proper management and treatment.