Tarsal Coalition — Rigid Flatfoot in Adolescents Michigan

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

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What Is Tarsal Coalition — The Pediatric Flatfoot That Needs Imaging

Tarsal coalition is an abnormal connection (cartilaginous, fibrous, or bony) between two or more tarsal bones that prevents the normal motion between those joints. The most common types are calcaneonavicular coalition (between the calcaneus and navicular — approximately 53% of cases) and talocalcaneal coalition (between the talus and calcaneus — approximately 37%). Tarsal coalitions present in adolescence (ages 8–16) when the coalition ossifies and the previously cartilaginous connection stiffens — producing a rigid flat foot, progressively reduced subtalar and midtarsal joint motion, and activity-related hindfoot and ankle pain. The condition is frequently misdiagnosed or undiagnosed for years because: initial X-rays may appear near-normal (the coalition is not obvious on standard views); the presentation is labeled as “flat feet” or “ankle sprain” without further imaging; and the symptoms are attributed to growth-related pain. At Balance Foot & Ankle in Howell and Bloomfield Hills, Michigan, Dr. Tom Biernacki, DPM identifies tarsal coalitions and coordinates appropriate management. Call (810) 206-1402.

Clinical Presentation — The Clues That Should Trigger Imaging

Tarsal coalition clinical clues: age of onset 8–16 years (when ossification occurs); rigid flat foot — the arch does not reconstitute when the patient stands on tiptoe (compare to flexible flat feet where the arch appears on tip-toe); peroneal spastic flat foot — involuntary contraction of the peroneal muscles (visible as a rigid flat foot with the foot held in pronation and the peroneals visible under tense skin) is pathognomonic for subtalar coalition; hindfoot and ankle pain with activity, particularly on uneven ground; restricted subtalar inversion-eversion range of motion; and pain pattern that worsens progressively with the adolescent’s activity level. The subtle X-ray sign for calcaneonavicular coalition: the “anteater nose” sign on lateral X-ray — the anterior process of the calcaneus elongates toward the navicular. CT is required to characterize the coalition completely — MRI provides superior evaluation for cartilaginous and fibrous coalitions before ossification.

Conservative Management — When It Succeeds and When It Fails

Conservative management of tarsal coalition: acute pain management with cam boot immobilization for 4–6 weeks to reduce peroneal spasm and joint inflammation; custom orthotics with a rigid medial posting that limits subtalar motion and reduces the stress at the coalition; and physical therapy for peroneal stretching and hindfoot mobilization. Conservative success: 50–60% of calcaneonavicular coalitions respond sufficiently to conservative management to avoid surgery in the short term; talocalcaneal coalitions have lower conservative success rates (30–40%). Predictors of conservative failure: coalition with secondary arthritis (visible on CT as joint space narrowing and osteophyte formation); coalition involving >50% of the posterior facet (talocalcaneal); and patients with high activity demands who cannot tolerate the motion restrictions that conservative management requires.

Surgical Resection — Outcomes in Adolescents

Surgical resection of the coalition (removal of the abnormal bone bridge) is the definitive treatment for symptomatic coalitions that fail conservative management in adolescents before secondary arthritis develops: calcaneonavicular resection — excision of the coalition through a lateral oblique approach, interposition of the extensor digitorum brevis muscle belly to prevent re-ossification; excellent outcomes in 80–90% when performed before secondary subtalar arthritis; talocalcaneal resection — more technically demanding, best reserved for coalitions involving less than 50% of the posterior facet with no secondary arthritis; outcomes 70–80% in appropriately selected patients. Recovery: cast 4–6 weeks, return to sport 3–4 months. When secondary arthritis is present, resection outcomes are poor — arthrodesis (fusion) of the arthritic joints is the appropriate surgical treatment.

Tarsal Coalition Evaluation in Howell & Bloomfield Hills Michigan

Dr. Tom Biernacki, DPM evaluates adolescent rigid flat feet and suspected tarsal coalitions with clinical examination, CT coordination, and conservative management at Balance Foot & Ankle. Surgical resection is coordinated with appropriate pediatric orthopedic or podiatric surgical partners. Any adolescent with rigid flat feet, restricted subtalar motion, or activity-related hindfoot pain should be evaluated for tarsal coalition. Serving Howell, Brighton, Macomb, Bloomfield Hills, and all Southeast Michigan. Book your evaluation or call (810) 206-1402.

Tarsal Coalition & Pediatric Flatfoot Treatment in Michigan

Tarsal coalition is a common cause of rigid flatfoot in adolescents that often goes undiagnosed. Our podiatrists specialize in pediatric foot conditions and use advanced imaging to identify coalitions and create age-appropriate treatment plans.

Learn About Our Pediatric Foot Care Services → | Book Your Appointment | Call (810) 206-1402

Clinical References

1. Stormont DM, Peterson HA. The relative incidence of tarsal coalition. Clin Orthop Relat Res. 1983;(181):28-36.
2. Mosca VS. Subtalar coalition in pediatrics. Foot Ankle Clin. 2015;20(4):265-281.
3. Kulik SA, Clanton TO. Tarsal coalition. Foot Ankle Int. 1996;17(5):286-296.

Your Board-Certified Podiatrists

Dr. Tom Biernacki, DPM

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Dr. Tom Biernacki, DPM

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.