SportsMed Podiatry | tarsal coalition
A tarsal coalition is where two or more bones within the mid-foot and/or rear-foot are joined together. The connection can be either osseous (bone), cartilaginous or fibrous. 90% of tarsal coalitions are either talocalcaneal (intra-articular) or calcaneonavicular (extra-articular) (Franson & Baravarian, 2004). They can cause pain, limited movement during walking and running and muscle spasm (Downey, 2011).
Tarsal Coalition, mid-foot pain, rear-foot pain
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23 Oct What is a Tarsal Coalition and how can it affect a Runner’s foot?

A tarsal coalition is where two or more bones within the mid-foot and/or rear-foot are joined together.  The connection can be either osseous (bone), cartilaginous or fibrous.  90% of tarsal coalitions are either talocalcaneal (intra-articular) or calcaneonavicular (extra-articular) (Franson & Baravarian, 2004).  They can cause pain, limited movement during walking and running and muscle spasm (Downey, 2011).

What are the Tarsal Bones?

The tarsal bones include the talus, calcaneus (heel bone), navicular cuboid and cuneiform bones.

Causes of the Tarsal Coalition?

Most often a tarsal coalition occurs during fetal development resulting in the individual bones not forming properly (Foot Health Facts, 2017).  They may be an acquired condition but are less common (Franson et al., 2004).  Less common causes are infection, arthritis or a previous injury to the area (Foot Health Facts, 2017).

How does a Tarsal Coalition cause pain while running?

The tarsal bones are extremely important in allowing the foot to be an adaptor and shock absorber by “unlocking” when a running foot initially contacts the ground.  They should also then lock together as the heel is lifting off the ground so that the foot can become a “rigid” lever to allow efficient force generation from the foot and lower limb muscles.

If there is a block not allowing certain tarsal bones to function normally during the walking or running gait cycle then this can cause an increase stress at the joint that is trying to bend.  This can also cause muscles and tendons to become overused as they are placed at a mechanical disadvantage during movement.  Also compensation at other joints because of the lack of movement may occur leading to pain.

Symptoms

A patient with a tarsal coalition may be symptomatic or asymptomatic.  Symptoms don’t usually occur until after the tarsal bones begin to mature between the ages of 9 to 16 (Foot Health Facts, 2017).  This can be because of the cartilaginous nature of the coalition until it begins to ossify and therefore further restrict motion (Franson et al., 2004).

Sometimes symptoms will not present themselves until even later in life especially if the patient is involved in repetitive activities such as long distance running.  Symptoms can also show up after an injury such as an ankle sprain that does not seem to be responding to normal treatment (Downey, 2011).

A list of symptoms may include (Foot Health Facts, 2017):

  • Pain while standing, walking and/or running
  • Tired or fatigued legs
  • Muscles spasms in the leg causing the foot to turn outwards when walking
  • Rigid Flat foot
  • Walking with a limp
  • Stiffness of the foot and ankle

Diagnosis

Involves your clinician taking a thorough history of symptoms, past injury history, duration of discomfort, past treatments and conducting a thorough biomechanical examination of the foot and ankle to find possible restrictions of movement.

Ordering an x-ray, an MRI and/or CT scan is also of prime importance to confirm a coalition if it suspected, the type and to rule out other possible causes of pain.

Treatment  

If a tarsal coalition is found as an incidental finding and no pain exists then treatment is not recommended (Downey, 2011).

If symptoms do exist then the primary goal of treatment is to improve a patient’s quality of life by reducing symptoms and restoring as much function as possible (Downey, 2011).   Conservative treatment is always considered first before considering surgery and below are some of the conservative treatments that are used.

  • Correct running and casual footwear to help reduce load through affects joints
  • Shoe Modifications & additions such as padding and wedges to help as above
  • Physical Therapy may include soft tissue release and strengthening exercises
  • Orthotic devices can be beneficial in distributing the weight away from the joint and limiting motion at the joint.
  • Immobilisation by using a moon boot or casting may be used to rest and offload the affected area/s
  • Oral Medications such as non-steroidal anti-inflammatory drugs (NSAIDs) may be helpful in reducing pain and inflammation.
  • Steroid injections may be used to help decrease pain and inflammation.

Failing conservative treatment a referral to a foot and ankle surgeon is required.  This may also be done during the conservative management period so all options are laid out for the runner.

References

Foot Health Facts. 2017. Tarsal Coalitions. [ONLINE] Available at: https://www.foothealthfacts.org/conditions/tarsal-coalition. [Accessed 22 October 2017].

Franson, J. and Baravarian, B. (2004). How To Detect And Treat Tarsal Coalitions | Podiatry Today. [online] Podiatrytoday.com. Available at: http://www.podiatrytoday.com/article/3155 [Accessed 23 Oct. 2017].

Downey, M. (2011). Keys To Treating Tarsal Coalitions | Podiatry Today. [online] Podiatrytoday.com. Available at: http://www.podiatrytoday.com/keys-treating-tarsal-coalitions [Accessed 23 Oct. 2017].

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