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Family Foot Care & Surgery, LLC

Tarsal Coalition: Bars between Bones

When builders don’t want two separate but adjacent objects to move around, they find ways to bolt them together. They might be fused or soldered to each other, or they might have a cross beam attached to both. Objects that are supposed to be able to move, even just a little, can’t have something pinning them in place. That is the danger of tarsal coalition for adolescents: abnormal tissue growth stiffens their midfoot joints and flattens the arches.

Unnatural Fusing

Tarsal coalition is a problem with abnormal bone growth in children and adolescence that can limit normal foot motion. Sometimes bone, cartilage, or fibrous connective tissue develops between two or more of the tarsals, preventing the bones from gliding under pressure and distributing weight properly. Typically the condition develops in the womb, if the bones do not form correctly. By adolescence, then, stiff “bars” of tissue connect several of the normally separate bones.

Your child then develops pain when he or she stands or walks. The stiffness in your midfoot may change his or her gait and fatigue the legs more quickly than normal. Often this causes rigid flatfoot as well. Your child may also have a limp or complain of painful muscle spasms.

The Anatomy of a Healthy vs. Rigid Midfoot

You have seven foot bones called tarsals. These make up your ankle, heel, and midfoot. The calcaneus, your heel bone, is the largest. Directly above it is your talus, or ankle bone. In front of these, making up the high part of your arch, are the cuboid, navicular, and three cuneiform tarsals. These bones are all held in place by ligaments and protected by smooth cartilage. This allows them to glide slightly to adjust to both the pressure of your body weight and the terrain below you.

In a foot with tarsal coalition, tissue abnormally connects two or more of these. These bars are commonly found between the calcaneus and navicular, or between the calcaneus and the talus, though any other tarsals could fuse together as well. The stiffness between the bones makes it difficult for your foot to adapt to uneven ground. Over time, the stiffness and stress this creates can actually lead to arthritis.

Alleviating the Discomfort

Many times the condition can be managed conservatively, especially if it’s caught early enough. Dr. Sanjay Patel and our expert staff will carefully examine your child’s painful lower limbs to accurately diagnose the problem. We will need diagnostic images, like X-rays, to confirm and locate the bars of tissue. Then we can work to relieve the discomfort.

The strain on your child’s midfoot will have to be reduced. This may mean spending time in a walking cast or special splints to stabilize and ease the affected bones. He or she will also need to take a break from all hard-impact activities for a few weeks. Once the discomfort has disappeared, your child will begin wearing special custom orthotics that brace the arches and help distribute the stress on the tarsals more evenly through the feet. This also reduces the abnormal motion in the lower limbs. If the feet are not responding to normal conservative treatment, you child may need surgery to cut the bar of tissue.

Tarsal coalition is an abnormal source of flatfoot, but it can cause long-lasting pain if it isn’t addressed appropriately. Your child doesn’t have to limp around or give up his or her activities, however. Don’t wait until your son or daughter needs surgery to feel better. Let Family Foot Care & Surgery, L.L.C., take care of the pain now. Use our website or call to make an appointment at one of our two locations: call (203) 876-7736 for the Milford office, or (203) 288-4055 for the Hamden location.

Dr. Sanjay V. Patel
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Dr. Patel has over 20 years of experience in the field of podiatric medicine and podiatric surgery.