Pediatric Tarsal Coalitions

Pediatric tarsal coalition occurs when two tarsal bones fuse, causing rigid flat foot. Conservative treatment using custom orthotics is usually successful.

Identifying and Treating Tarsal Coalition in Children

What Is Tarsal Coalition?

Tarsal coalition occurs when two of the tarsal bones form an abnormal connection. The connection may be fibrous, cartilaginous, or osseous (bone).

The tarsal bones in the back and mid-foot include the heel bone (calcaneus), cuboid, cuneiform, navicular, and talus. In a healthy foot, these bones work together to help distribute weight and propel the body forward when walking. When tarsal coalition occurs, two of the bones fuse together, which leads to rigid flat foot and may cause pain when walking or standing.

A graphic representation of tarsal coalition
(A graphic representation comparing a normal foot bone structure with tarsal coaltion)

Pediatric Tarsal Coalition Causes

For most children, tarsal coalition is genetic, meaning it occurs during fetal development. Less commonly, the condition may develop after an injury, infection, or because of arthritis.

Tarsal Coalition Symptoms

The majority of children with tarsal coalition – around 75 percent – have no symptoms and therefore do not require treatment. When symptoms do appear, it is typically after the bones begin maturing, from around age 9 to 16.

Tarsal coalition symptoms may include:

  • Flatfoot
  • Foot and ankle stiffness
  • Gait abnormalities
  • Legs easily becoming tired or fatigued
  • Mild to severe pain when walking or standing
  • The foot turning outward when walking due to muscle spasms in the leg

The initial complaint is usually a painful, rigid flat foot. When you view the child standing or walking, you will see little motion in the heel. Your child will likely indicate pain in the midfoot that increases with activity. They may also complain of muscle pain or spasms on the lower leg.

Child pointing to pain area on heel
Tarsal coalition stance

Diagnosing Tarsal Coalition in Children

To diagnose tarsal coalition, Dr. Jarman takes a full medical history and conducts a thorough physical exam. Your pediatric podiatrist will also observe your child’s gait, looking for signs like the foot collapsing and the toes pointing outward while walking.

Dr. Jarman will also have your child stand both flat and on their toes to see whether the heel straightens.

In addition to the physical exam, Dr. Jarman uses digital x-rays to evaluate the type and severity of the coalition. Specifically, he’s looking for a talocalcaneal or calcaneum navicular coalition. These common coalitions are not always obvious in a clinical exam, which is why Dr. Jarman typically orders either a CT or an MRI to help diagnose the location and extent of the coalition.

Conservative Treatment for Tarsal Coalition in Children

Most children respond very well to conservative (non-surgical) treatment. Dr. Jarman begins by “calming” the coalition. This essentially means immobilizing the foot by placing it in a boot or cast for a short period.

Next, he prescribes an orthotic. This is a custom-made shoe insert that supports the foot and ensures proper weight distribution.

Dr. Jarman treating tarsal coalition with a custom orthotic
Doctor fitting a custom orthotic to treat a tarsal coalition

Do Children Ever Need Surgery to Treat Tarsal Coalition?

If conservative treatment fails, your pediatric podiatrist may recommend surgery. Surgical resection is recommended when your child is experiencing pain and conservative treatment has failed. We see the best results and fastest recoveries in coalition resection when patients are younger.

Coalition resection is an outpatient procedure, and the child is often able to bear weight in a walking boot the same day of surgery. After around 3 weeks, the child transitions back to regular footwear, with normal activities added as tolerated.

xray of a tarsal coalition before surgery
xray of a tarsal coalition after surgery

An accurate diagnosis of your child’s condition is vital to ensuring proper treatment. If your child has foot pain and their current treatment doesn’t seem to be working, please call Pediatric Foot & Ankle today to schedule a consultation.

Your child’s feet are designed for life

Make an appointment today if you suspect your child may have tarsal coalitions.