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A Tarsus coalition is an abnormal connection of two or more bones on the foot.The affected bones, called tarsal bones, are found on the back of the foot and heel, and bone connection can cause a severe and rigid flat foot.

Although the Tarsus coalition is often present at birth, children usually show no signs of disorder until early adolescence.The foot can become rigid and painful, and everyday physical activities are often difficult.

For many children with tarsal coalition, symptoms are relieved with simple treatments such as orthose and physical therapy.If a child has serious symptoms that do not respond to simple treatments and continue to interfere with their daily activities, surgery may be recommended.


The bones of the feet are commonly divided into three parts: the rear, the middle and the forefront.Say bones, called tarsals, make up the rear and midf.In the Tarsus coalition.

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Calcaneous, astragalus and navicular bones are the most affected by the Tarsus coalition.

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A tarsal coalition occurs when two bones grow together, connected by a bone bridge, cartilage or strong and fibrous fabric.These bridges are often called "bars" and can cover only a small amount of joint space between bones, or a lot of space.

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The two most common sites of the Tarsus coalition are between the bones of the calcaneus and the navicular, or between the bones of the handle and the calcaneal.However, other joints may also be affected.

It is estimated that one in 100 people may have a Tarsus coalition.In approximately 50% of cases, both feet are affected.The exact incidence of the disorder is difficult to determine because many coalitions never cause remarkable symptoms.

In most people, the condition begins before birth.It is caused by a genetic mutation that affects cells that produce bones of tarsus.Although the coalition is formed before birth, its presence is usually not discovered until childhood or late adolescence.

This is because the feet of babies contain a larger percentage of soft cartilage hardens and fuse the growing bones, along with a solid bone bridge or fibrous fabric similar to a scar.The ossification of the coalition usually occurs between the ages of 8 and 16 years, depending on what bones are involved.It is hardened, causing pain and other symptoms.

Stress and stress produced by tarsal coalitions can lead to arthritis over time.

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This x -ray image of a right foot shows a tarsal coalition between the navicular bone and the bone of the calcaneus.

Courtesy of the hospital of Rito Scottish of Texas for Children


Many Tarsus coalitions never find out why they do not cause symptoms or any obvious deformity of the foot.When symptoms occur, they may include:

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  • Rigid and painful feet.The pain usually occurs under the ankle around half or back of the foot.
  • A rigid and smooth foot that makes it difficult to walk on unequal surfaces.To accommodate the lack of movement of the foot, the patient can roll the ankle more than normal, which can cause recurring ankle sprains.
  • Greater pain or soft with higher levels of activity.

Medical exam

Medical History and Physical Examination

After discussing your symptoms and overall health history, your doctor will take a complete examination of the foot and ankle, which will include checking the flexibility and march of your foot.Patients with tarsal coalitions may have a flat bow that is not completely corrected pushing the toes and lifting the heel.

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(Left) A side view of a young man with boring foot.(BOM) The feet remain flat when they increase the feet.

Image Tests

To accurately diagnose the number, location and scope of the coalition (s), your doctor will request images of your foot and ankle.

  • X ray.These tests provide clear images of the bone.Many coalitions are visible on radiographs.
  • Computed tomography (CT).The images produced with computed tomography provide more bone details.Computerized tomography are the standard for the image of Tarsus coalitions, because they can show more subtle bars that can be lost with simple radiographs.

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This CT image shows a cross view of the posterior foot and shows a great coalition that fuses the heel and calcaneal bones.

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Reproduced with permission of the Tarsus Pierz Ka coalition.Orthopedic Knowledge Line 8/1/2009.Concontrowed in December 2013.

  • Magnetic resonance imaging (magnetic resonance imaging).These image tests provide detailed images that include soft tissues.


Tarsal coalitions only require treatment if they are causing symptoms.

Non -surgical treatment

  • Rest.Take a break from high impact activity for a period of 3 to 6 weeks, can reduce stress in tarsus bones and relieve pain.
  • OrthosesArc support, shoe insertions such as heel and wedge cups and other types of orthose can be recommended to help stabilize the foot and relieve pain.
  • Put the temporal division.These options can immobilize the foot and remove the tension from tarsal bones.
  • InjectionsSteroid medications can be used along with other non -surgical options to provide temporary pain relief.

Surgical treatment

When non -surgical treatments are not effective in relieving pain or improving function, your doctor may consider surgery.

The surgical procedure that your doctor recommends will depend on the size and location of the coalition, as well as if the joints between the bones showed signs of arthritis.

  • Resection.In this procedure, the coalition is eliminated and replaced by muscle or fat tissue from another area of the body.This is the most common surgery for the Tarsus coalition because it preserves normal foot movement and successfully relieves symptoms in most patients who have no signs of arthritis.

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These CT cross section images show a patient with coalition between the calcaneus and the astragal in both feet.At the moment of this scan, the coalition on the left foot had been dry and the right foot was waiting for the procedure.

Reproduced with permission of the Tarsus Pierz Ka coalition.Orthopedic Knowledge Line 8/1/2009.Concontrowed in December 2013.

  • Fusion.The largest and most serious coalitions that cause significant deformity and also involve arthritis can be treated with joint fusion.The purpose of the merger is to limit the movement of the painful joints and place the bones in the proper position.Melting to the tarsal coalition, bones can be kept in place with large screws, pins or screw and plate devices.


Depending on the type and location of your surgery, a cast will be required for a period of time to protect the surgical site and prevent the weight of putting weight.Molds are usually replaced by walking boots, and your doctor may recommend physical therapy exercise to start restoring the amplitude of motion and strength.

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Your doctor will determine when you will surely start putting weight on your foot.

Although it may be recovering several months, most patients have pain relief and improve movement after surgery.

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Revised by members of
POSNA (North America Pediatric Orthopedic Society)

The Pediatric Orthopedic Society of North America (Post) is a group of eligible/certified orthopedic surgeons by the Council Council that have specialized training in the musculoskeletal health care of children.

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Get more information about this topic on the post's Orthakids website:

Tarsus coalitions

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