A Tarsal Coalition is a congenital condition that affects the bones of the foot in children and adolescents. The two most common types are the calcaneonavicular coalition and the talocalcaneal coalition.
Tarsal coalition becomes a problem because it affects the way the bones of the foot move as we walk. In the past, this condition was called peroneal spastic flatfoot because doctors thought that the flattening of the foot was associated with spasms of the peroneal muscles that run along the outside of the calf.
The primary symptom caused by a tarsal coalition, no matter whether it is a calcaneonavicular coalition or a talocalcaneal coalition, is pain. After making the diagnosis, your doctor may recommend placing the foot in a walking cast or a brace from the knee to the toes for two to four weeks. When the condition continues to be painful despite non-surgical treatment, your doctor may recommend surgery. When the coalition occurs between the calcaneus and the navicular, excision can be highly successful.
When the coalition occurs between the talus and the calcaneus, excision is less predictable. A fusion, also called an arthrodesis is a surgical procedure that is usually done when a joint becomes worn out and painful. A triple arthrodesis fuses three bones together: the calcaneus, the navicular and the cuboid.
When a cast is used to rest the foot, most children learn to walk in the cast fairly rapidly. After surgery for excision of the tarsal coalition, a large bandage is applied to the foot.
I had a blister on the ball of my foot so I compensated by running on the outer edge I guess.
The support this gave to my arches and feet took a lot of strain off of areas if my foot not built for straining.


Congenital means that the condition is present at birth and occurred during fetal development. The calcaneonavicular coalition describes a failure of separation between the calcaneus and the navicular, while the talocalcaneal coalition describes a failure of separation between the calcaneus and the talus. The purpose of the cast is to place the joints at rest and allow the inflammation and irritation to decrease.
Surgery for tarsal coalition falls into two categories: 1) surgery to remove or excise the bar and attempt to restore normal motion between the two bones or 2) surgery to fuse the affected joints together solidly. To perform this procedure, an incision is made in the lateral side of the foot immediately over the sinus tarsi. To perform this procedure, an incision is made in the medial side of the foot under the medial malleolus.
This type of arthrodesis is commonly used to treat any tarsal coalition that is too advanced to consider an excision and the condition has affected other joints in the foot. The next day I did my usual 3 mile recovery run and I was sore all over so I just went with it.
To function correctly, all of the bones of the foot must move in relationship to each other. If these joints are affected, pain may be felt on the top of the foot and on the outside of the foot.
The doctor will watch the child walk and pay particular attention to the way the feet move during gait.
Once the surrounding joints have become excessively worn, or degenerative, restoring motion may not be enough to stop the pain. A muscle called the extensor digitorum brevis is detached from the bone and moved out of the way. The procedure is done by removing the cartilage that covers the joint surfaces and allowing the bone surfaces to heal together or fuse as one bone.
Weight bearing can usually be started in a few days, as soon as the pain and swelling subside.


A tarsal coalition occurs when this type of failure to separate occurs in the tarsal bones of the foot.
Finally, examination of the feet is necessary to locate areas of tenderness and look for restriction of motion in each of the joints in the foot. The MRI scan also makes slices of the foot but it shows soft tissue much better than the CT scan.
Once the pain has stopped, the cast is removed and special orthotics are custom made for everyday use. Once all of the bone connecting the talus and calcaneus is removed, the empty space is filled with a piece of fat tissue taken from the lower leg. This type of arthrodesis is used when the joints in the rest of the foot are still in good shape and do not seem to be causing pain.
Each of these types represents a different degree of attachment between the two bones, with the stiffest being bone and the most flexible being fibrous tissue. Most problems that affect the joint between the talus and the calcaneus, the subtalar joint, seem to be felt in this area.
Once all of the bone connecting the calcaneus and the navicular is removed, the empty space is filled with the extensor digitorum brevis muscle. Weight bearing may be delayed up to six or eight weeks to make sure that the fusion is healing and the bones are showing satisfactory healing on x-ray. The orthotic supports the foot, reduces the abnormal motion and reduces the pain with walking. Similar to placing muscle between the two bones, the fatty tissue prevents the bone from growing back and recreating the bar.
Placing the muscle between the two bones prevents the bone from growing back and recreating the bar or coalition.




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