Tarsal Coalition Treatment Michigan | Pediatric & Adult Flatfoot

Quick answer: Tarsal Coalition Michigan is a common foot/ankle topic that affects many patients. Effective treatment starts with a targeted diagnosis, conservative-first treatment, and escalation only when needed. We treat this regularly at our Howell and Bloomfield Hills practices. Call (810) 206-1402.

Related Conditions

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

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

Schedule your tarsal coalition evaluation at Balance Foot & Ankle in Howell, Brighton, or Bloomfield Hills, Michigan.

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In-Office Treatment at Balance Foot & Ankle

If home treatment isn’t providing relief for your tarsal conditions, our podiatry team at Balance Foot & Ankle can help with same-day evaluations and advanced in-office care.

Frequently Asked Questions

When should I see a podiatrist?

See a podiatrist if: foot or ankle pain has lasted more than 2–4 weeks without improvement, you’re changing your gait to avoid pain, you have an open wound or sore that isn’t healing, you notice nail discoloration or thickening, you have diabetes and any foot concern, or pain is severe enough to wake you at night. Most foot conditions are easier and cheaper to treat early — what starts as a minor issue can become a surgical problem with months of delay.

What is the difference between a podiatrist and an orthopedic surgeon?

Podiatrists (DPM — Doctor of Podiatric Medicine) specialize exclusively in the foot, ankle, and lower leg. Orthopedic surgeons (MD/DO) have broader musculoskeletal training but variable foot/ankle subspecialization. For foot and ankle-specific problems, a podiatrist often has more focused training and experience. For injuries involving the leg above the ankle, complex pediatric cases, or multi-level reconstruction, orthopedic consultation may be appropriate. We frequently co-manage patients with orthopedic colleagues.

How do I know if my foot pain is serious?

Signs that warrant same-day or next-day evaluation: severe pain that appeared suddenly without clear cause, swelling, redness, and warmth that appeared suddenly (possible gout, infection, or Charcot fracture), an open wound that looks infected (redness spreading, pus, warmth), inability to bear weight, or any foot problem in a diabetic patient. Pain that’s been present for weeks and is stable is important but not an emergency — schedule within 1–2 weeks.

Can foot problems cause back and knee pain?

Yes — this is a kinetic chain effect. Abnormal foot mechanics (overpronation, supination, leg length discrepancy) cause compensatory changes in knee, hip, and lumbar alignment. Roughly 30% of patients presenting to our clinic with knee pain have a treatable foot-level biomechanical cause. Correcting foot mechanics with orthotics or appropriate footwear often provides significant knee and back relief. If you have chronic knee or back pain and haven’t had your foot mechanics evaluated, it’s worth a consult.

Are orthotics worth it?

For the right conditions, yes — custom orthotics are among the most cost-effective interventions in podiatry. They’re most effective for: plantar fasciitis, flat feet with secondary knee/back pain, leg length discrepancy, metatarsalgia, posterior tibial tendon dysfunction, and diabetic foot pressure management. Quality OTC orthotics ($35–60) resolve symptoms for 60% of patients with mild-to-moderate conditions. Custom orthotics are appropriate when OTC options have failed or when the biomechanical problem is complex. We cast custom orthotics in-office.

How do I choose the right running shoes?

Start with your foot type (flat, neutral, high arch) and running pattern (overpronator, neutral, supinator). Flat feet and overpronators do best in stability or motion-control shoes. Neutral feet do well in neutral-cushioned shoes. High arches need maximum cushioning with flexible soles. Always buy running shoes at the end of the day (foot swelling peaks then), get properly fitted by a specialist, and replace every 300–500 miles. If you’ve been injured repeatedly, a gait analysis can identify the mechanical flaw driving your injury pattern.

What is the difference between a sprain and a fracture?

A sprain is a ligament injury (the tissue connecting bones); a fracture is a break in the bone itself. Both can occur with the same trauma (ankle roll, fall). The old test — ‘if you can walk, it’s not broken’ — is wrong; many fractures are initially weight-bearable. Key differences: a fracture typically produces localized bone tenderness along the bone itself, while a sprain is tender over the ligament. X-ray is the standard to differentiate. High-grade sprains without proper treatment can be as disabling as fractures.

How do I prevent foot and ankle injuries?

The four most impactful prevention strategies: (1) Supportive, appropriately fitted footwear for your foot type and activity. (2) Gradual activity progression — the 10% rule (never increase weekly mileage or intensity by more than 10%). (3) Regular calf and ankle mobility work. (4) Strengthening the posterior tibial tendon, peroneals, and intrinsic foot muscles. Most overuse injuries are preventable; most acute injuries are not — but ankle sprain recurrence (60–70% without rehab) is prevented by balance and proprioception training.