Tarsal coalition is a condition characterised by the abnormal connection of two or more tarsal bones located at the hind and midfoot. The two most common types of tarsal coalution involve the calcaneus, talus and navicular bones, which may be connected by fibrous tissue (fibrous coalition), catilage (cartilaginous coalition) or bone (bony coalition).
The symptoms of tarsal coalition can vary depending depending on the severity of the condition, age, and the specific bones involved. Early stage patients may be asymptomatic, although as the bones harden into later childhood and adolescence, symptoms can become more pronounced.
These include pain in the hind or midfoot, stiffness and limited range of motion, as well as the development of a flatfoot deformity. Tarsal coalition can also contribute to fatigue in the affected limb, as well as swelling and gait changes. If left untreated, it can contribute to the development of arthritis.
Tarsal coalition is, most commonly, a function of genetic factors contributing to the abnormal formation of the bones of the foot during pregnancy. Certain other conditions can predispose individuals to coalition, including clubfoot, flatfoot and arthrogryposis.
Less commonly, trauma or infection may cause abnormal connections to form between the tarsal bones during the healing process.
Non-surgical treatment options are reserved for mild cases, and aim to reduce symptoms and slow the progression of the condition. They include:
Surgical treatment options include:
Resection: involves the surgical removal of the bony, cartilaginous or fibrous connections between the tarsal bones. The space created may be filled with soft tissue to avoid re-fusion in a procedure known as soft tissue interposition.
Joint fusion (arthrodesis): reserved for patients with very severe or extensive coalitions, this involves the permanent fusion of the affected tarsal bones to eliminate movement at the joint.
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Professor Dr Munjed Al Muderis is an orthopaedic surgeon specialising in osseointegration, hip, knee and trauma surgery. He is a clinical professor at Macquarie University and The Australian School Of Advanced Medicine, a fellow of the Royal Australasian College of Surgeons and Chairman of the Osseointegration Group.