Tarsal Coalition in Adolescents: Calcaneonavicular and Talocalcaneal Coalition Diagnosis and Treatment

Tarsal coalition — an abnormal bridge of bone, cartilage, or fibrous tissue connecting two tarsal bones — is a congenital condition that produces progressive hindfoot and midfoot stiffness in adolescence as the coalition matures and ossifies. The two most common coalitions — calcaneonavicular (CN) and talocalcaneal (TC, specifically at the middle facet of the subtalar joint) — together account for 90% of all tarsal coalitions and present with a distinctive clinical pattern of activity-related hindfoot pain and rigidity in teenagers.

Clinical Presentation and Diagnosis

Typical presentation: a 10–15 year old presenting with hindfoot or midfoot pain that worsens with prolonged standing and athletic activity; bilateral in 50–60% of cases; associated flatfoot deformity; peroneal spasm (‘peroneal spastic flatfoot’) — involuntary spasm of the peroneal muscles producing a valgus hindfoot posture that resists manual correction. Physical examination: restricted subtalar inversion-eversion (the hallmark finding); pain with subtalar range of motion; the ‘too many toes’ sign on standing. Imaging: CN coalition: lateral X-ray shows the ‘anteater sign’ — elongation of the anterior calcaneal process extending toward the navicular; oblique X-ray shows the coalition directly. TC coalition: Harris (axial) heel view shows narrowing or sclerosis of the middle facet; CT scan is the definitive diagnostic test for TC coalition — shows the bone bridge, its extent, and any secondary degenerative changes. MRI: identifies fibrocartilaginous (non-osseous) coalitions that are invisible on CT.

Treatment

Conservative management: orthotics with motion control to reduce subtalar motion; activity modification; immobilization in a cast or boot for acute flare; cortisone injection at the coalition site. Surgical resection: CN coalition resection — direct excision of the coalition with interposition of the extensor digitorum brevis muscle to prevent re-ossification; 85–90% success rate for pain relief; appropriate when <50% of subtalar joint is arthritic. TC coalition resection: excision of the middle facet coalition via medial approach; results less predictable than CN resection; appropriate for coalitions <50% of the middle facet. Subtalar fusion: for coalitions with secondary subtalar arthritis, failed resection, or large coalition size — sacrifices motion in exchange for pain relief. Dr. Biernacki at Balance Foot & Ankle evaluates pediatric and adolescent hindfoot stiffness with X-ray and CT to identify and manage tarsal coalition. Call (810) 206-1402 at our Bloomfield Hills or Howell office.

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Frequently Asked Questions

When should I see a podiatrist?

See a podiatrist for any foot or ankle pain that persists more than 2 weeks, doesn’t improve with rest, limits your daily activities, or is accompanied by swelling, numbness, or skin changes. People with diabetes or circulation problems should see a podiatrist regularly even without symptoms.

What does a podiatrist treat?

Podiatrists diagnose and treat all conditions of the foot, ankle, and lower leg including plantar fasciitis, bunions, hammertoes, toenail problems, heel pain, nerve pain, diabetic foot care, sports injuries, fractures, and foot deformities — both surgically and non-surgically.

What can I expect at my first podiatry visit?

Your first visit includes a full medical history, physical examination of your feet and gait, and in-office diagnostic imaging if needed (X-rays, ultrasound). We’ll discuss your diagnosis and create a plan tailored to your foot type. Most visits take 30–45 minutes.

Need Treatment at Balance Foot & Ankle?

Dr. Tom Biernacki, Dr. Carl Jay, and Dr. Daria Gutkin see patients at our Howell and Bloomfield Hills offices.

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Most Common Mistake We See

The most common mistake we see is: Waiting too long before seeking care. Fix: any foot pain lasting more than 4 weeks, or any sudden severe symptom, deserves a professional evaluation rather than more rest.

Warning Signs That Need Same-Day Care

What is Foot pain?

Foot pain is a common foot/ankle condition that affects mobility and quality of life. Understanding the underlying cause is the first step in successful treatment. Our podiatrists at Balance Foot & Ankle perform a hands-on biomechanical exam, review your activity history, and use diagnostic imaging when appropriate to identify the root cause—not just treat the symptom. Many patients have been told to “rest and ice” without a deeper diagnostic workup; our approach is different.

Symptoms and warning signs

Common signs of foot pain include pain that worsens with activity, morning stiffness, swelling, tenderness when palpated, and difficulty bearing weight. If you experience sudden severe pain, inability to walk, visible deformity, numbness or color change, contact our office the same day or visit urgent care—these can signal a more serious injury such as a fracture, tendon rupture, or vascular compromise. Diabetics with any foot wound should seek same-day care.

Conservative treatment options

Most cases of foot pain respond to non-surgical care: structured rest, supportive footwear changes, custom orthotics, targeted stretching and strengthening protocols, anti-inflammatory medications when medically appropriate, and in-office procedures such as ultrasound-guided injections. We also offer advanced therapies including MLS laser therapy, EPAT/shockwave, regenerative injections, and image-guided procedures. Treatment is sequenced from least invasive to most invasive, and we explain the rationale at every step.

When is surgery considered?

Surgery is reserved for cases that fail 3-6 months of well-structured conservative care, when there is structural pathology (severe deformity, complete tear, advanced arthritis), or when imaging shows damage that will not heal without intervention. Our surgeons have performed 3,000+ foot and ankle procedures and prioritize minimally-invasive techniques whenever appropriate. We discuss recovery timelines, return-to-activity milestones, and realistic outcome expectations before any procedure is scheduled.

Recovery timeline and prevention

Recovery from foot pain varies based on severity and chosen treatment path. Conservative cases often improve within 4-8 weeks with consistent adherence to the protocol. Post-procedural recovery may range from a few days (in-office procedures) to several months (reconstructive surgery). Long-term prevention involves footwear assessment, activity modification, structured strengthening, and regular check-ins with your podiatrist if you have a history of recurrence. We provide written home-exercise plans and digital follow-up support.

Visit Balance Foot & Ankle — Same-Day Appointments Available

Our podiatry team serves patients throughout Michigan including Howell, Brighton, and Bloomfield Hills. If you’re dealing with heel pain, ingrown toenails, or a foot injury, we have same-day appointment availability.