From the Research
Tarsal coalition should be initially managed with conservative treatment, including activity modification, orthotic devices, and short-term immobilization, and if this fails, surgical intervention with arthroscopic resection of the coalition is a viable option, as it has been shown to be effective with minimal complications, as seen in a systematic review of arthroscopic management 1.
Key Points
- Tarsal coalition is a congenital condition where two or more bones in the foot are abnormally connected, typically affecting the calcaneus, navicular, or talus bones.
- Patients often present with foot pain, stiffness, and flat feet, with symptoms typically appearing during adolescence when the coalition begins to ossify.
- Initial treatment is conservative, including activity modification, orthotic devices, and short-term immobilization with a walking boot for 4-6 weeks, as well as anti-inflammatory medications like ibuprofen or naproxen to manage pain.
- If conservative measures fail after 3-6 months, surgical intervention may be necessary, either to resect the coalition or fuse the affected joints, with arthroscopic resection being a viable option, as it has been shown to be effective with minimal complications 1.
- The condition occurs due to failure of mesenchymal tissue segmentation during embryonic development, affecting approximately 1% of the population, with talo-calcaneal and calcaneo-navicular coalitions accounting for over 90% of all cases of tarsal coalition 2.
Treatment Options
- Conservative treatment: activity modification, orthotic devices, short-term immobilization, anti-inflammatory medications
- Surgical treatment: arthroscopic resection of the coalition, open resection, or fusion of the affected joints
Important Considerations
- Early diagnosis and appropriate management are crucial to prevent long-term foot dysfunction and pain.
- Arthroscopic resection of the coalition has been shown to be effective with minimal complications, making it a viable option for treatment 1.
- The decision to proceed with surgical intervention should be based on the location of the pain, the size and histology of the coalition, the health of the posterior subtalar facet, the degree of flatfoot deformity, and the presence of degenerative changes in the subtalar and/or adjacent joints 3.