Conditions

Tarsal Coalition

What is tarsal coalition?

Tarsal coalition is a type of flatfoot. It occurs when 2 or more of the tarsal bones, found in the middle and back of the foot, join together. These bones are usually separate. 

Tarsal coalition is a type of rigid flatfoot. The feet of children with this condition look the same as the feet of children with other forms of flatfoot. Their feet angle outward from the leg, and they do not have an arch in the middle. But feet with a tarsal coalition are stiff, not flexible, like some other forms of flatfoot. 

Only about 1 in 4 of people who have tarsal coalition have problems with it or need treatment. Of those who need treatment, about one-third to one-half of people are helped without surgery. 

What causes tarsal coalition?

Tarsal coalition is a genetic condition. Parents with tarsal coalition can pass it on to their children. It is not linked with any other medical problems. Babies are not born with a tarsal coalition. Instead, their bones join together and their feet flatten out as they get older, usually between the ages of 8 and 16. 

Which foot bones are involved?

Each of the tarsal bones has a name. The most common sites for a tarsal coalition are between the calcaneus and navicular bones and between the talus and calcaneus bones. About half of cases involve the first set of bones, and about half involve the second set. In some cases, both sets of the bones are joined together in the same foot. 

Why choose Seattle Children’s for tarsal coalition treatment?

Our experts in our Foot and Ankle Deformities Program, which is part of Orthopedics and Sports Medicine, treat tarsal coalition.

  • The foot experts you need are here
    • Our Foot and Ankle Deformities team includes experienced pediatric , , and nurses who know how to evaluate and treat all types of foot and ankle conditions.  
    • To restore or improve your child’s health, function and quality of life, we often use nonsurgical methods, like cutting back on activity for a while or wearing a cast or rigid boot. Your child’s treatment may not involve surgery at all, or at least not at first.
    • We recommend surgery only when we believe it will give your child the best results. For those who need surgery, we have pediatric orthopedic surgeons with expanded fellowship training in foot and ankle conditions.  
  • Treatment designed for growing bodies
    • Infants, children and teens are still developing, so they may need different care than adults do, like treatment that takes their growth plates into account. At Seattle Children’s,  your child’s team has special training in the physical, emotional and social needs of young people.
    • We understand your child’s body doesn’t stop at their foot and ankle. We see them as a whole person. For example, in our Foot and Ankle Deformities Program, we look at not only your child’s feet and ankles but also their legs, spine, strength, movement and other features that might play a role in their condition, like nerve problems.
    • We have the largest group of board-certified pediatric radiologists in the Northwest. For imaging that uses radiation, we use the lowest amount possible (PDF) to make the best image. We have a low-dose radiation X-ray machine, called the EOS. It makes safer full-body images.  
  • Support for the whole family
    • Having a child with a foot or ankle condition can be stressful for the whole family. From the first visit to follow-up, our team will work to give your child seamless care and make your experience here as easy on you as we can.
    • Your child’s team does more than plan and provide care for your child. We also make sure you and your child understand your child’s condition and treatment options. We support you in making choices that are right for your family.
    • Seattle Children’s supports your family with a range of resources. Our Child Life specialists, Family Resource Center and Guest Services are here to help. 
  • Research to improve care
    • Seattle Children’s is active in the Pediatric Foot Research Group, an international group of researchers studying foot and ankle differences in children.  
    • Our growing research program is discovering better ways to diagnose and care for children with this condition. For example, we are looking for ways to reduce the need for repeat surgery after an operation to remove a tarsal coalition. Our research program is funded in part by the Lynn Taylor Staheli Endowed Chair in Pediatric Orthopedics.
    • Outcomes research helps us know which treatments get the best results for children. For example, we use tools to ask children about their function after surgery for limb differences. Asking children about their experience is essential to improving their lives.
    • We take part in several registries (databases that collect information about patients who volunteer) so we can work with doctors around the country and the world to better understand orthopedic conditions, such as foot, leg, hand and arm differences.
    • Learn more about current orthopedics research at Seattle Children’s. 

What are the symptoms of tarsal coalition?

Children with tarsal coalition may have foot pain. Usually, you cannot see an arch in their foot or feet when they stand up.

How is tarsal coalition diagnosed?

First, the doctor examines your child’s foot and ankle. We look at your child’s feet as they stand up. We may ask your child to stand on tiptoe or dangle their foot in the air as they sit on an exam table.

When children have rigid flatfoot, such as a tarsal coalition, we usually cannot see the arch when they stand on tiptoe or let their foot hang down. In other types of flatfoot, the arch appears when children stand on tiptoe or let their feet dangle. 

We also check the in your child’s feet and ankles. If your child’s ankle does not move much, it could mean that the  is short or tight. This may make it more likely they will have pain and disability, like trouble walking, running or playing sports. 

The doctor may ask for X-rays to see if your child’s calcaneus and navicular bones are joined together. To check the talus and calcaneus bones, we use a CT (computed tomography) scan.

How is tarsal coalition treated?

The goal of treatment for tarsal coalition is to end your child's pain.

Nonsurgical Treatment for Tarsal Coalition

We treat all children with tarsal without surgery whenever possible.

If your child’s case is mild, this means cutting back on the activities that cause pain and taking anti-inflammatory medicines. Physical therapy might also be helpful. 

If your child has more severe pain, they may need to wear a cast or a rigid boot for about 6 weeks to hold their foot still. This is called immobilization treatment. Some children’s feet will remain free of pain after we remove the cast or boot. 

Surgery for tarsal coalition

For pain that comes back or continues after we have tried immobilization, we offer a full range of surgical options. We recommend surgery based on your child’s needs and how severe and complex their condition is. 

Surgery for mild tarsal coalition: 

  • In early and mild cases, we may do an operation to remove the tarsal coalition. Then the doctor puts fat or a small nearby muscle in the place of the tarsal coalition.
  • After this operation, your child will wear a cast for 3 weeks. They are not allowed to walk on the foot for at least 6 weeks. We teach your child exercises to help them regain movement in the joints of their feet. 

Surgery for severe or widespread tarsal coalitions: 

  • For children with the most severe and widespread tarsal coalitions and those with the flattest feet, joint-preserving surgery may help. We developed this procedure at Seattle Children’s. 
  • Our research shows that the operation for flexible flatfoot (calcaneal-lengthening osteotomy) also works to relieve pain and correct the deformity of severe tarsal coalitions. 

Contact Us

Contact Orthopedics and Sports Medicine at 206-987-2109 for an appointment, a second opinion or more information.

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