Tarsal Coalition Treatment Michigan
Tarsal coalition is an abnormal connection (bony, cartilaginous, or fibrous) between two or more of the tarsal bones in the hindfoot or midfoot. It is an under-recognized cause of rigid flatfoot and ankle pain in children, adolescents, and young adults. The two most common coalitions are calcaneonavicular (between the calcaneus and navicular) and talocalcaneal (between the talus and calcaneus at the middle facet). Dr. Tom Biernacki DPM at Balance Foot & Ankle treats tarsal coalition in Michigan at our Howell, Brighton, and Bloomfield Hills locations.
Why Tarsal Coalition Causes Symptoms
Normal hindfoot function requires motion across multiple subtalar and midtarsal joints during walking. When two tarsal bones are fused or tethered, this motion is blocked, placing abnormal stress on adjacent joints and restricting arch flexibility. Symptoms typically develop in adolescence (10–16 years) when coalitions ossify (harden to bone) and fully restrict motion — often mistaken for “growing pains” or ankle sprains.
Symptoms
- Rigid or semi-rigid flatfoot that does not correct on tiptoe standing
- Activity-related pain in the hindfoot, ankle, or lateral foot
- Recurrent ankle sprains (subtalar stiffness predisposes to sprains)
- Peroneal muscle spasm (peroneal spastic flatfoot)
- Limited subtalar inversion/eversion range of motion
Diagnosis
Standard weight-bearing X-rays may show calcaneonavicular coalition on oblique view or “C-sign” for talocalcaneal coalition on lateral view. However, CT scan is the definitive imaging modality — it precisely defines coalition type, size, percentage of joint involvement, and presence of secondary degenerative changes. MRI identifies fibrous or cartilaginous coalitions and associated bone marrow edema.
Treatment
Conservative treatment with CAM boot immobilization for 4–6 weeks followed by custom orthotics and activity modification is effective for symptomatic control in mild cases. Corticosteroid injection at the coalition site (under CT or ultrasound guidance) reduces acute inflammation.
Surgical resection of the coalition with interposition of fat or muscle is the treatment of choice for calcaneonavicular coalitions (high success rate) and for talocalcaneal coalitions involving less than 50% of the posterior facet without significant secondary arthritis. Recovery: non-weight-bearing for 4–6 weeks, followed by physical therapy and return to sport at 3–4 months.
Hindfoot fusion (subtalar or triple arthrodesis) is required when secondary degenerative changes are present or when resection has failed. Provides reliable pain relief at the cost of subtalar motion.
Frequently Asked Questions
Can an adult have a tarsal coalition?
Yes — while symptoms typically appear in adolescence, tarsal coalitions may present in adults who have been managing pain with activity modification or who develop secondary arthritis. CT scan diagnosis and coalition resection or arthrodesis can provide significant relief in appropriately selected adults.
Is tarsal coalition hereditary?
Yes — tarsal coalition has an autosomal dominant inheritance pattern with variable expressivity. It is bilateral in approximately 50–60% of cases. Family members of diagnosed patients should be evaluated if they have rigid flatfoot or chronic ankle pain.
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Schedule your tarsal coalition evaluation at Balance Foot & Ankle in Howell, Brighton, or Bloomfield Hills, Michigan.
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Our board-certified podiatrists treat this condition at two convenient locations. Same-day appointments often available.
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.
- Diagnosis and Treatment of Plantar Fasciitis (PubMed / AAFP)
- Heel Pain (APMA)
- Hallux Valgus (Bunions): Evaluation and Management (PubMed)
- Bunions (Mayo Clinic)