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

What Is Tarsal Coalition?

Tarsal coalition is an abnormal connection between two or more tarsal bones — the bones of the hindfoot and midfoot. This connection may be bony (synostosis), cartilaginous (synchondrosis), or fibrous (syndesmosis). The coalition prevents normal motion between affected bones, creating the characteristic rigid flatfoot appearance and activity-related pain that typically emerges in adolescence when the fibrous or cartilaginous coalition begins to ossify.

Why Symptoms Emerge in Teenagers

Many coalitions are present from birth but remain asymptomatic in childhood when the abnormal connection is still flexible fibrous or cartilaginous tissue. As ossification occurs during adolescence (typically ages 10-16 depending on coalition type), motion loss and pain develop. The calcaneonavicular coalition — the most common type — typically becomes symptomatic around ages 8-12, while talocalcaneal coalition presents later, around 12-16.

Recognizing Tarsal Coalition

Classic features include: rigid or semi-rigid flatfoot that doesn’t reconstitute an arch on tip-toe, limited subtalar (hindfoot) motion (especially inversion-eversion), peroneal muscle spasm causing the heel to tilt outward, and activity-related midfoot or hindfoot pain in an otherwise healthy teenager. Many adolescents with coalition are initially treated for ankle sprains before the correct diagnosis is made. Standard X-rays may suggest coalition; CT scan provides definitive characterization.

Treatment Options

Conservative treatment — immobilization, orthotics, activity modification — manages mild to moderate symptoms. When conservative treatment fails, surgical resection of the coalition (removing the abnormal connection and interposing fat or muscle to prevent recurrence) restores motion and relieves pain in carefully selected patients. Advanced deformity with degenerative changes in adjacent joints may require fusion rather than resection. The podiatric surgeons at Balance Foot & Ankle in Howell and Bloomfield Township evaluate adolescents with suspected coalition and coordinate care with orthopedics when indicated.

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Balance Foot & Ankle — Howell & Bloomfield Township, MI

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Rare Foot Pain in a Teenager? It Could Be Tarsal Coalition

Tarsal coalition is an often-missed cause of rigid flat feet and foot pain in adolescents. Dr. Tom Biernacki recognizes this condition early and provides appropriate treatment ranging from orthotics and immobilization to surgical correction.

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Clinical References

1. Lemley F, et al. Tarsal coalition: current concepts. Journal of the American Academy of Orthopaedic Surgeons. 2006;14(8):477-487.
2. Cass AD, Camasta CA. A review of tarsal coalition and pes planovalgus: clinical examination, diagnostic imaging, and surgical planning. Journal of Foot and Ankle Surgery. 2010;49(3):274-293.
3. Varner KE, Michelson JD. Tarsal coalition in adults. Foot and Ankle International. 2000;21(8):669-672.

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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.