Tarsal Coalition: Calcaneonavicular and Talocalcaneal Types, Diagnosis, and Surgical Resection

Medically reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatric Surgeon — Balance Foot & Ankle, Howell & Bloomfield Hills, MI. Last updated April 2026.

Tarsal coalition — an abnormal cartilaginous, fibrous, or osseous fusion between two or more tarsal bones resulting from failure of normal mesenchymal segmentation during fetal development — is the most common structural cause of rigid, painful flatfoot in adolescents and young adults, present in 1–2% of the population but symptomatic in a smaller proportion. The two most clinically significant coalitions are calcaneonavicular (CN) coalition (most common, 53%) and talocalcaneal (TC) coalition at the middle facet (second most common, 37%), each requiring specific imaging for diagnosis and a distinct surgical approach for resection.

Clinical Presentation and Imaging

Clinical features: peroneal spastic flatfoot is the classic presentation — rigid hindfoot valgus with peroneal muscle spasm preventing subtalar inversion; the subtalar joint is stiff or absent on examination; pain localized to the sinus tarsi (TC coalition) or dorsolateral midfoot (CN coalition); symptoms typically begin in early adolescence (10–16 years) as the coalition ossifies and becomes rigid. Plain X-rays: CN coalition — lateral X-ray shows the ‘anteater sign’ (elongated anterior calcaneal process pointing toward the navicular); oblique view directly visualizes the bar. TC coalition at middle facet — Harris heel axial view shows narrowing, sclerosis, and irregular borders of the middle facet; often missed on standard views. CT scan: gold standard for osseous coalition — defines the extent of fusion, identifies middle facet TC coalitions, and assesses the posterior subtalar facet for degenerative changes (key surgical planning factor). MRI: superior for fibrocartilaginous coalitions not visible on CT; shows marrow edema adjacent to the coalition. Surgical contraindication: posterior subtalar arthritis on CT is a relative contraindication to coalition resection — subtalar fusion provides more reliable outcomes when significant arthritic change is present.

Surgical Resection Technique

CN coalition resection: extensor digitorum brevis (EDB) muscle interposition; oblique incision over the sinus tarsi; identification and complete resection of the calcaneonavicular bar with osteotomes; EDB flap interposed into the resection space to prevent re-coalition; outcomes: 80–90% good-excellent in adolescents without hindfoot arthritis. TC middle facet coalition resection: medial approach over the sustentaculum tali; complete resection of the middle facet coalition; fat graft or split flexor hallucis longus tendon interposition; concurrent calcaneal osteotomy for significant residual valgus deformity after resection. Outcomes: good-excellent in 70–80% of patients without posterior facet arthritis; subtalar fusion indicated for coalition with posterior facet arthrosis. Dr. Biernacki at Balance Foot & Ankle diagnoses tarsal coalition with CT/MRI and performs resection and hindfoot reconstruction at our Bloomfield Hills and Howell offices. Call (810) 206-1402.

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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.