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

Tarsal Coalition: Abnormal Bone Bridges in the Hindfoot

Tarsal coalition is a congenital abnormality in which two or more of the tarsal bones of the hindfoot are abnormally connected — either by bone (synostosis), cartilage (synchondrosis), or fibrous tissue (syndesmosis). This abnormal connection reduces or eliminates normal joint motion between the affected bones, causing pain, restricted movement, and often a rigid flatfoot deformity. Tarsal coalition is present in approximately 1% of the population but is significantly underdiagnosed — many patients with coalition-related symptoms are treated for years as simple flat feet or plantar fasciitis before the coalition is identified. At Balance Foot & Ankle in Howell and Bloomfield Township, Michigan, we evaluate adolescent flat feet and hindfoot pain with tarsal coalition in mind.

Why Symptoms Appear in Adolescence

Tarsal coalition is present from birth, but symptoms typically emerge in the early teenage years (10-16). The reason: coalitions are initially cartilaginous and relatively flexible. As they ossify (become bone) during adolescent skeletal development, they become increasingly rigid and begin restricting motion that the foot previously had. The transition from flexible to rigid coalition causes the symptom onset that brings teenagers to podiatric care. Parents may notice the teenager’s flat foot has become more prominent, or the teenager reports foot pain with sports that previously caused no problems.

Two Most Common Types

Calcaneonavicular coalition: abnormal bridge between the anterior calcaneus and navicular bone — visible on oblique foot X-rays as a characteristic “anteater nose” radiographic sign. This is the most common type, occurring in approximately 53% of coalitions. Talocalcaneal coalition: abnormal bridge at the middle facet of the subtalar joint — more difficult to see on plain X-rays, often requiring CT scan for diagnosis and characterization. CT is the gold standard for evaluating coalition extent and surgical planning — MRI is used when cartilaginous or fibrous coalitions are suspected that may not appear on CT.

Treatment Based on Severity and Age

Conservative management: short leg cast immobilization for 4-6 weeks relieves acute pain by resting the coalition; custom orthotics for mild coalitions provide ongoing support. Surgical treatment is appropriate when conservative management fails. For calcaneonavicular coalition: resection (removal of the coalition bar) with fat graft interposition allows restoration of some joint mobility and relieves pain in appropriately selected younger patients (under 16 with good hindfoot alignment). For talocalcaneal coalition with good outcomes predictors (small coalition area, no significant arthritis): resection may be considered. For coalitions with substantial arthritis or failed resection: subtalar or triple arthrodesis (fusion) provides reliable pain relief. Contact Balance Foot & Ankle at (810) 206-1402 for adolescent foot pain evaluation that considers tarsal coalition in the differential.

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When to See a Podiatrist for Tarsal Coalition

Tarsal coalition — where two foot bones are abnormally connected — is a hidden cause of flat feet, foot pain, and recurrent ankle sprains in teens and young adults. At Balance Foot & Ankle, Dr. Tom Biernacki diagnoses tarsal coalitions with CT imaging and provides both conservative management and surgical resection when needed.

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Clinical References

1. Lemley F, Berlet G, Hill K, et al. Current concepts review: tarsal coalition. Foot Ankle Int. 2006;27(12):1163-1169.
2. Mosier KM, Asher M. Tarsal coalitions and peroneal spastic flat foot: a review. J Bone Joint Surg Am. 1984;66(7):976-984.
3. Saxena A, Erickson S. Tarsal coalition: activity, surgery, and MRI review. Foot Ankle Spec. 2003;6(2):10-14.

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Dr. Tom Biernacki, DPM is a double board-certified podiatrist and foot & ankle surgeon at Balance Foot & Ankle Specialists in Southeast Michigan. With over a decade of clinical experience, he specializes in heel pain, bunions, diabetic foot care, sports injuries, and minimally invasive surgery. Dr. Biernacki is a member of the APMA and ACFAS, and his patient education content on MichiganFootDoctors.com and YouTube has reached over one million views.