Tarsal Coalition (Rigid Flatfoot)

It is a condition where an abnormal connection is seen between the bones of the foot. Typically, it occurs before birth, with symptoms seen in late childhood or during teenage years.
Mostly, it affects children and teenagers, with symptoms seen between the ages of nine and sixteen. It may cause pain and stiffness that may impact daily activities.

Symptoms of Tarsal coalition

Though the condition does not always cause painful symptoms or deformities, in some cases, you may notice these symptoms:

• Walking difficulty because of flat feet
• Stiffness or pain in the middle or back portion of the foot
• Pain during moderate to high levels of activity
• Limp may be seen while walking
• Muscle spasms in the leg

Causes of Tarsal coalition

Typically, tarsal coalition happens because of improper development of foot bones during fetal development. A gene mutation affects the cells responsible for producing the tarsal bones, causing the condition. Though a genetic condition in most cases, it may also be possible to develop it because of an injury or infection. 

Types of Tarsal Coalition 

Depending on the bones that have an abnormal connection, the tarsal coalition may be calcaneonavicular (most common type), talocalcalcaneal, talonavicular, etc.

Treatment at Maruti Clinic for Children Orthopaedics 

We conduct a full examination of the child’s foot and ankle and ask for the complete medical history. We examine the child’s foot to evaluate its flexibility and assess if the child has a flat arch that does not correct upon certain manoeuvers or when the child is standing on the toes.

We ask the child to describe any pain or stiffness felt and determine what activities worsen the pain or ease it. The child’s running and walking are observed to understand the mechanics of the foot better.

To confirm the diagnosis, we order tests that include:

• X-rays: They give an overview of the bones in the foot
• CT scans: As they show greater detail than X-rays, we often recommend CT scans to diagnose tarsal coalition
• MRI: They help get images of soft tissues and bones and also help visualise the fibrous coalition, which may be present sometimes.

Treatment options: In cases where the condition causes no pain or discomfort, treatment is usually not needed. Only annual checkups at our clinic are recommended in such cases to address issues that may develop as the child grows.
When Tarsal Coalition causes symptoms, we treat it with surgical or non-surgical methods based on the condition’s severity and age.

Non-surgical methods: 

• Medications: We may recommend anti-inflammatory medicines for pain relief and to reduce swelling. 
• Rest: To relieve stress and pain, the child may need to temporarily stop activities that are causing flare-ups. Three to six weeks of rest is usually enough.
• Orthotic devices: We recommend shoe inserts or other devices to stabilize the foot, enable the distribution of the child’s weight, restrict the motion at the affected joint, and relieve pain.
• Temporary cast or boot: In some cases, we place the foot in a temporary cast or boot to prevent movement and remove extra stress on the tarsal bones.

Surgical methods:

If non-surgical techniques do not help improve the condition, we consider surgery. Based on the child’s age, condition’s severity, and activity level, we recommend either resection or fusion surgery.

Resection: We remove the tarsal coalition and replace it with tissue or muscle from another body part. It helps preserve normal foot function.

Fusion: Joint fusion is the other procedure to treat severe cases of tarsal coalition. Screws, staples, or plates are used to keep the bones in place and keep the bones in a better position.

Following surgery, we apply a cast to the foot and ankle to safeguard the surgical site, immobilize the joint, and prevent the child from putting extra weight on the affected foot. We remove the cast after few weeks and replace it with a walking boot. We then prescribe physical therapy or orthotic devices to help restore the strength and range of motion.

At Maruti Clinic for Children Orthopaedics, we offer your child ongoing support and services to ensure improved motion and pain relief. With comprehensive treatment and personalized care, we focus on improving the quality of life for your child.