A tarsal coalition is an abnormal connection between two bones in the hindfoot. This abnormal connection can be composed of bone, cartilage, or fibrous tissue, and may lead to limited motion and pain in one or both feet.
Tarsal coalition typically occurs during fetal development, resulting in the individual bones not forming properly.
Symptoms
Many patients who have a tarsal coalition are born with this condition, the symptoms generally do not appear until the bones begin to mature. At times there are no symptoms during childhood. However, pain and symptoms may develop later in life.
The symptoms of tarsal coalition may include the following:
- Pain when walking and/or standing
- Tired and/or fatigued legs
- Muscle spasms in the leg, causing an outward turn to the foot
- Limp
- Stiffness
Diagnosis
Tarsal coalition is difficult to identify until bones begin to mature. At times it is not discovered until adulthood. Diagnosis includes obtaining information about the duration and development of the symptoms as well as a thorough examination of the foot/ankle.
X-rays will be ordered to assess the condition. At times advanced imaging such as a CT scan or MRI will be ordered to determine the extent of the pathology to the soft tissue and bone as well as determine surgical planning should surgery be warranted.
Non-surgical Treatment
The goal of non-surgical treatment of tarsal coalition is to relieve the symptoms and reduce the motion at the affected joint.
- Ice. Putting an ice pack on your foot for 20 minutes several times a day helps reduce inflammation.
- Limit activities. Reduce extended physical activities.
- Medications. Oral nonsteroidal anti-inflammatory drugs (NSAIDs) may be prescribed to reduce pain and inflammation.
- Physical therapy. Physical therapy may include strengthening exercises, mobilization, ambulation education, and stretching.
- Injection therapy. In some cases, corticosteroid injections are used to help reduce the inflammation and relieve pain. Sometimes more than one injection is necessary.
- Orthotic devices. Custom orthotic devices can be beneficial in distributing weight away from the joint, limiting motion at the joint and relieving pain.
- Immobilization. Sometimes the foot is immobilized to give the affected area a rest.
Surgery
Depending on the amount of damage to the cartilage in the ankle joint, arthritis may develop and limit joint motion. Treatment for this may be different then in the early stages of the OCD lesion.
If non-surgical approaches fail to relieve the symptoms of an OCD, surgery may be necessary. Your surgeon will select the best procedure to repair the OCD lesion which may involve removal of the loose bone and cartilage fragment as well as arthroscopically cleaning the joint of any inflammation.
Surgery is typically an outpatient procedure (day surgery) and scheduled at your convenience.
A splint or boot will be placed on your surgical foot/ankle after surgery. No weight to the surgical foot/ankle is advised until your surgeon encourages weight bearing (typically 6 weeks post surgery).