Medically reviewed by Dr. Tom Biernacki, DPM
Board-certified podiatric surgeon | Balance Foot & Ankle, Howell & Bloomfield Hills, MI
Last reviewed: May 2026
Balance Foot & Ankle offers same-day appointments for urgent foot and ankle conditions across Southeast Michigan — but the most important factor in outcomes isn’t getting seen quickly. Our podiatrists explain what to do in the first 24-48 hours before your appointment that most patients skip entirely. Call (810) 206-1402 — expert podiatric care across Michigan.
| Coalition Type | Age at Symptom Onset | Ossification Age | Radiographic Diagnosis | CT Criterion for Resection |
|---|---|---|---|---|
| Calcaneonavicular (CN) | 8–12 years | 8–12 years (earliest to ossify) | Oblique foot X-ray: “anteater sign”; lateral X-ray: elongated anterior calcaneal process | Full CN bar present → resection if no subtalar OA; >50% navicular surface → arthrodesis |
| Talocalcaneal Middle Facet (TC) | 12–16 years | 12–16 years (later ossification) | Lateral X-ray: C-sign, talar beaking, absent middle facet; CT required to measure coalition extent | <50% of middle facet surface area → resection; >50% → subtalar arthrodesis |
| Talonavicular | Variable; rare | Variable | Ball-and-socket ankle; pan-talonavicular arthritis | Surgical resection rarely appropriate; talonavicular arthrodesis for pain |
| Procedure | Indication | Interposition Material | Success Rate | Recovery |
|---|---|---|---|---|
| CN Coalition Resection | Symptomatic CN coalition; no secondary OA; <50% navicular surface | EDB muscle belly (gold standard) or fat graft | 80–92% good outcomes; best results under age 16 without OA | NWB 4–6 weeks; 3–4 months full activity |
| TC Coalition Resection | TC coalition <50% middle facet; no subtalar OA; patient under 16 | Fat graft (EDB too far to reach TC coalition); bone wax hemostasis | 70–80% if ≤50% joint; drops significantly above threshold | NWB 4–6 weeks; 4–5 months full activity |
| Subtalar Arthrodesis | TC coalition >50% joint; secondary subtalar OA; failed resection; over 16 with OA | No interposition — fusion | 85–90% pain relief; eliminates subtalar motion | NWB 8–10 weeks; 6 months full activity |
| Triple Arthrodesis | Multiple coalition sites; pan-subtalar OA; severe rigid flatfoot deformity | No interposition | 80–85%; permanent motion restriction | NWB 10–12 weeks; 12 months full recovery |
Medically Reviewed | Dr. Tom Biernacki, DPM | Board-Certified Podiatric Surgeon | Balance Foot & Ankle, Michigan
The most important clinical decision with Tarsal Coalition Rigid Flat Foot Adolescent Michigan Podiatrist isn’t which treatment to start with — it’s identifying the correct subtype. That changes everything. Call (810) 206-1402.
What Is Tarsal Coalition?
Tarsal coalition is an abnormal bridge — fibrous (syndesmosis), cartilaginous (synchondrosis), or bony (synostosis) — between two tarsal bones that normally remain separate. The most common types are the calcaneonavicular coalition (between the calcaneus and navicular, accounting for approximately 45% of cases) and the talocalcaneal coalition (between the talus and calcaneus at the middle facet, accounting for approximately 45%). Bilateral involvement occurs in 50–60% of patients. Coalition is a congenital condition that becomes symptomatic as the coalition ossifies during adolescence — typically between ages 8 and 16.
How Does Tarsal Coalition Cause Problems?
A tarsal coalition eliminates normal motion between the fused bones. The subtalar joint complex normally provides approximately 30 degrees of combined inversion-eversion motion — essential for adapting to uneven ground and absorbing torsional forces during gait. When coalition eliminates this motion, the surrounding joints and soft tissues are overstressed. The result is a rigid or semi-rigid flat foot with limited subtalar motion, painful peroneal muscle spasm (the peroneals contract reflexively to protect the irritated joint), and activity-related medial and lateral ankle pain. Patients often have difficulty with uneven surfaces, sports, and prolonged standing.
Diagnosis at Balance Foot & Ankle
The clinical triad of restricted subtalar motion, rigid flat foot, and peroneal spasm in an adolescent should prompt immediate suspicion for tarsal coalition. Weight-bearing X-rays may show secondary signs — the “anteater sign” in calcaneonavicular coalition or the “C-sign” and talar beaking in talocalcaneal coalition — but CT scan is the gold standard for definitive diagnosis and coalition characterization. MRI adds value in fibrous/cartilaginous coalitions that are CT-negative, and in assessing arthritic changes that influence surgical planning. Dr. Biernacki orders the appropriate advanced imaging at the first suspicion of coalition.
Conservative Management
Mild coalitions without significant arthritic change can be managed conservatively. Dr. Biernacki’s non-surgical protocol includes: custom orthotics with medial longitudinal arch support to reduce subtalar stress; short-leg cast or walking boot immobilization for 4–6 weeks during acute peroneal spasm episodes; activity modification; and anti-inflammatory medication. Conservative care provides meaningful relief in approximately 30–40% of patients with calcaneonavicular coalition and less consistently in talocalcaneal coalition. It is particularly useful as a temporizing measure in younger patients not yet ready for surgery.
Surgical Resection of Tarsal Coalition
When conservative management fails or significant arthritic change is absent, surgical coalition resection is highly effective for appropriately selected patients. For calcaneonavicular coalition, Dr. Biernacki excises the bar through a lateral approach and interposes extensor digitorum brevis muscle to prevent re-coalition — an outpatient procedure with excellent outcomes in 80–90% of cases. For middle facet talocalcaneal coalition, resection with fat graft interposition is performed — a more technically demanding procedure with good outcomes in carefully selected cases without significant hindfoot arthrosis. Advanced cases with arthritis may require triple arthrodesis (fusion of subtalar, talonavicular, and calcaneocuboid joints) to eliminate painful arthritic motion.
Dr. Tom's Product Recommendations
Powerstep ProTech Full Length Orthotics
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Firm arch support OTC orthotic — useful for mild tarsal coalition cases and as a bridge during conservative management before surgical decision-making.
Dr. Tom says: “”Dr. Biernacki recommended these OTC orthotics while we monitored my son’s coalition — helped significantly with activity pain.” — Michigan parent”
Adolescents with mild tarsal coalition managed conservatively who need arch support during activity
Those with rigid complete bony coalition requiring cast immobilization or surgery — orthotics alone are insufficient
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Aircast Walking Boot (Low Top)
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Pneumatic walking boot for managing acute peroneal spasm episodes in tarsal coalition — provides immobilization and pain control during flares.
Dr. Tom says: “”My podiatrist put me in a boot during my coalition spasm episode — immediate relief from the peroneal cramping.” — Livingston County teenager”
Adolescent tarsal coalition patients experiencing acute peroneal spasm managed with boot immobilization
Post-resection surgical patients who need a different post-op protocol — follow surgeon-specific instructions
Disclosure: We earn a commission at no extra cost to you.
✅ Pros / Benefits
- CT and MRI provide definitive diagnosis and surgical planning
- Calcaneonavicular resection has 80–90% good outcomes without arthritis
- Bilateral disease addressed in staged procedures
- Conservative care effective temporizing measure for mild cases
❌ Cons / Risks
- Talocalcaneal coalition has higher recurrence and more variable outcomes after resection
- Significant arthritic change requires fusion rather than resection
- Bilateral disease may require staged surgical treatment
- Coalition inevitably progresses to arthrosis if untreated long-term
Dr. Tom Biernacki’s Recommendation
Tarsal coalition is one of the most satisfying diagnoses to make — because it explains years of vague ankle pain, activity limitation, and recurrent peroneal spasm that other practitioners couldn’t figure out. When an adolescent comes in with a rigid flat foot that won’t mobilize, I order a CT immediately. When we catch a calcaneonavicular coalition before arthritis develops, the resection is a relatively straightforward operation with outstanding outcomes. Kids go from ‘I can’t play soccer’ to being fully athletic within 4 months.
— Dr. Tom Biernacki, DPM | Board-Certified Podiatric Surgeon | Balance Foot & Ankle
Frequently Asked Questions
Can tarsal coalition occur in adults?
Yes — while symptoms most often emerge in adolescents as the coalition ossifies, adults can remain asymptomatic for years before a specific injury or increased activity unmasks the coalition. Adult presentation typically involves more established arthritic changes, making conservative treatment less effective and fusion more likely to be needed.
How is tarsal coalition different from flat feet?
Flexible flat feet have normal or near-normal subtalar joint motion — the arch is present when non-weight-bearing or on tip-toe. Tarsal coalition produces a rigid flat foot with significantly restricted or absent subtalar motion that cannot be corrected actively or passively. This rigidity is the key distinguishing feature.
Does tarsal coalition require surgery?
Not always — mild coalitions with preserved motion and minimal arthritic change may be adequately managed with orthotics and activity modification. Surgery is recommended when conservative care fails, when the coalition is causing significant daily limitation, or when arthritic changes are minimal and the anatomy is favorable for resection.
What is the recovery after tarsal coalition resection?
After calcaneonavicular coalition resection with EDB interposition, patients are typically non-weight-bearing for 2–4 weeks, then in a walking boot for 4 additional weeks. Physical therapy begins at 6 weeks. Return to sport is typically at 3–4 months with full recovery at 6 months.
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When should I see a podiatrist?
If symptoms persist past 2 weeks, affect your normal activity, or are accompanied by red-flag symptoms (warmth, redness, swelling, inability to bear weight).
What does treatment cost?
Most diagnostic visits and conservative treatments are covered by Medicare and major insurers. Out-of-pocket costs vary by your specific plan.
How quickly can I get an appointment?
Most non-urgent cases see us within 5 business days. Urgent cases (sudden pain, possible fracture) typically same or next business day.
In-Office Treatment at Balance Foot & Ankle
If home treatment isn’t providing relief for your flat feet, our podiatry team at Balance Foot & Ankle can help with same-day evaluations and advanced in-office care.
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Dr. Tom Biernacki, DPM is a board-certified foot & ankle surgeon (ABFAS & ABPM) 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 made him one of the most-followed foot & ankle educators on YouTube.