Medically reviewed by Dr. Tom Biernacki, DPM
Board-certified podiatric surgeon | Balance Foot & Ankle, Howell & Bloomfield Hills, MI
Last reviewed: May 2026
Most patients underestimate how much the post-operative phase determines Tarsal Coalition : Resection vs. Fusion, & Results outcomes — not the surgery itself. Our podiatric surgeons identify the single recovery variable that separates patients who return to full activity on schedule from those who experience setbacks. Call (810) 206-1402 — expert podiatric care across Michigan.
A tarsal coalition is an abnormal bony, cartilaginous, or fibrous bridge between two or more tarsal bones. It restricts subtalar and midtarsal motion, causing a rigid flatfoot, peroneal spasm, and recurrent ankle sprains — often presenting in adolescence. When conservative care fails, surgery offers excellent results. Balance Foot & Ankle treats tarsal coalition in Howell and Bloomfield Hills, MI.
Tarsal Coalition Types at a Glance
| Coalition Type | Bones Involved | Frequency | Presentation Age | Key X-ray Sign |
|---|---|---|---|---|
| Calcaneonavicular (CN) | Calcaneus + navicular | ~45% of all coalitions | 8–12 years | “Anteater nose” sign on oblique X-ray |
| Talocalcaneal (TC) | Talus + calcaneus (middle facet) | ~45% | 12–16 years | “C-sign” on lateral X-ray; talar beak |
| Talonavicular | Talus + navicular | ~5% | Variable | Best seen on MRI or CT |
| Calcaneocuboid | Calcaneus + cuboid | ~3% | Variable | CT or MRI required |
| Bilateral | Both feet affected | 50–60% of cases | Variable | Bilateral imaging recommended |
Surgical Options: Resection vs. Arthrodesis
| Factor | Coalition Resection | Arthrodesis (Fusion) |
|---|---|---|
| Goal | Remove the coalition, restore motion | Fuse the affected joint(s), eliminate pain |
| Best candidate | CN coalition (<50% of facet involved); TC coalition <50%; no arthritis; skeletally immature | TC coalition >50% of middle facet; degenerative arthritis present; failed resection; adult patients |
| Motion after surgery | Preserved or improved | Eliminated at fused joint; compensated by adjacent joints |
| Interposition material | Fat graft (autologous), extensor digitorum brevis muscle, or bone wax to prevent re-coalition | N/A — bone graft for fusion |
| Success rate (pediatric) | CN: 80–90% good/excellent; TC: 70–85% | 85–95% for subtalar fusion; high patient satisfaction |
| Re-coalition rate | 10–15% without interposition; <5% with fat/EDB graft | Non-union ~5–10% in pediatric patients |
Tarsal Coalition Surgery Recovery
| Timeframe | Resection Recovery | Fusion Recovery |
|---|---|---|
| Weeks 0–4 | NWB in cast; strict elevation | NWB in cast; strict elevation |
| Weeks 4–6 | Transition to boot; early weight-bearing | Continued NWB; repeat X-ray |
| Weeks 6–10 | Progressive FWB in shoe; PT starts | Progressive FWB in boot as fusion develops |
| Months 3–4 | Return to sport for most patients | Transition to shoe; PT intensifies |
| Months 6–12 | Full return including competitive sports | Full activity; fusion mature at 6 months |
Conservative Treatment First
Surgery is considered only after conservative care has failed (typically 3–6 months): short leg cast immobilization for 4–6 weeks, custom orthotics to support the arch and limit subtalar motion, NSAIDs, and physical therapy. Corticosteroid injection into the coalition or sinus tarsi can provide temporary relief for diagnosis confirmation and symptom management.
When to Suspect Tarsal Coalition in a Child
- Rigid flatfoot that does not correct on tiptoe (unlike flexible flatfoot which does)
- Peroneal spasm — muscle goes into protective spasm; foot held in valgus/pronated position
- Recurrent ankle sprains in a child without trauma history
- Pain and stiffness after sports that worsens through adolescence
- Family history (autosomal dominant inheritance in some cases)
Contact Balance Foot & Ankle in Howell (4330 E Grand River Ave) or Bloomfield Hills (43494 Woodward Ave #208) at (810) 206-1402 for a tarsal coalition evaluation.
OrthoInfo – AAOS: Tarsal Coalition
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Doctor Answer
What is tarsal coalition surgery and when is it needed?
Tarsal coalition is an abnormal bony, cartilaginous, or fibrous bridge between two tarsal bones — most commonly calcaneonavicular or talocalcaneal — causing rigid flat foot and peroneal spasm. Conservative treatment with orthotics and a walking boot helps symptoms in flexible coalitions. Surgical resection of the coalition works well for calcaneonavicular bars diagnosed before secondary arthritis develops, with good results in appropriately selected patients. Talocalcaneal coalitions with significant subtalar arthritis may require subtalar fusion rather than resection for reliable pain relief.
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.