Download Tarsal Coalition A tarsal coalition is a bone condition that causes

Tarsal Coalition
A tarsal coalition is a bone condition that causes decreased motion or
absence of motion in one or more of the joints in the foot. The lack of
motion or absence of motion is due to abnormal bone, cartilage or fibrous
tissue growth across a joint. When excess bone has grown across a joint
there is usually little or no motion in that joint. Cartilage or fibrous tissue
growth can restrict motion of the affected joint to varying degrees causing
pain in the affected joint or in surrounding joints.
The decreased motion can cause pain in surrounding joints as they try to
compensate for the affected joint. When one joint has restricted motion the
surrounding joints will be stressed more than normal. This is an attempt to
"take up the slack" for the diseased joint.
Tarsal coalitions can occur outside of a joint as well. This is referred to as a
bar. A bar connects two bones that don't normally touch or have a joint
between them. The bar will limit motion in surrounding joints causing
abnormal wear and tear to the joints of the foot. This can lead to early
arthritis and pain. The bar itself can be painful as well if it is incomplete,
traumatized during walking, sporting activities, or an accident.
In the foot, the bones found at the top of the arch, the heel, and the ankle
are referred to as the tarsal bones. Thus, a tarsal coalition is an abnormal
connection between two of the tarsal bones in the back of the foot or the
arch. This abnormal connection between two bones is most commonly an
inherited trait and passed down from generation to generation. All coalitions
are not inherited though. They can also arise from outside sources such as
arthritis, infections, trauma and abnormal bone growth. These outside
causes are much less frequent.
Symptoms
Patients with a painful tarsal coalition commonly describe an aching
sensation deep in the foot near the ankle or arch. In many cases, muscle
spasm on the outside of the affected leg is present. This is a natural reaction
of the body as it tries to limit the painful motion occurring in the foot.
Patients may notice that the affected foot is not as flexible and appears
significantly more flattened when compared to the other foot. This only holds
true if only one foot is affected, as it is common for both feet to be affected.
All flat-footed people do not have tarsal coalitions. There are many causes of
flat feet.
Symptoms most commonly appear in the teenage or early adult years
depending on the location of the coalition. It should be noted that not all
tarsal coalitions become symptomatic. The onset of symptoms may be
delayed into adulthood.
Diagnosis
Diagnosis of a tarsal coalition can usually be made from symptoms described
by the patient to the doctor. X-rays are usually taken and in most cases a CT
scan or MRI will confirm the diagnosis and provide valuable information
regarding the type of coalition, its location, and how the joints have been
affected.
Treatment
There are a variety of methods to treat a tarsal coalition depending on the
severity of the condition, the age of the patient, and which joint is affected.
Conservative treatment involves non-surgical treatment options.
Conservative treatment is directed toward reducing motion in the affected
joints to decrease pain and muscle spasm. Orthotics (shoe inserts) are
commonly used accomplish this decrease in motion. Physical therapy and
anti-inflammatory medication may be utilized as well. Cortisone injections
in the affected area may provide relief for an indefinite period of time. These
conservative methods of treatment may or may not provide long-term relief.
If symptoms do persist surgical correction is often entertained. Surgical
intervention will vary depending on the type of coalition, its location, and the
amount of arthritis it has caused in the foot. Surgery can involve removing
the coalition to allow for more normal motion between the bones. Many
times surgery may involve fusing the affected joint or surrounding joints.
This is designed to limit or completely stop the painful motion of the affected
joints.
Recovery from surgery often involves a period of non-weight bearing on
crutches and utilization of a cast. Physical therapy will often be used once
the normal bone healing is complete to restore muscle tone and full available
range of motion.(For more information see Hindfoot and Ankle surgery.