Tarsal Coalition Treatment Richmond & Kensington

Overview

What Is Tarsal Coalition?

Talocalcaneal coalition — abnormal fusion between the talus and calcaneus compared to normal anatomy

Tarsal coalition is a condition in which two or more of the tarsal bones in the hindfoot or midfoot are abnormally joined together — either by bone (osseous), cartilage (synchondrosis) or fibrous tissue. This connection restricts the normal independent movement between those bones, leading to stiffness, pain and a progressive flatfoot deformity.

It is a congenital condition, present from birth as a failure of normal bone segmentation during foetal development. Symptoms typically emerge in late childhood or adolescence — most commonly between the ages of 8 and 16 — as the coalition begins to ossify and the foot can no longer compensate for the restricted motion.

Tarsal coalition is more common than many clinicians appreciate and is frequently misdiagnosed as recurrent ankle sprains, flat feet, or generalised foot pain. The two most common types are talocalcaneal coalition (involving the talus and calcaneus) and calcaneonavicular coalition (involving the calcaneus and navicular).

Types of Tarsal Coalition

Talocalcaneal coalition — the most clinically significant type, occurring at the middle facet of the subtalar joint. Causes rigid hindfoot valgus and is the most common cause of a painful rigid flatfoot in adolescents.

Calcaneonavicular coalition — the most common type overall, occurring between the anterior calcaneus and the navicular. Often visible on plain X-ray and typically presents slightly earlier, around age 8–12.

Talonavicular & other coalitions — less common but can occur at any of the tarsal articulations. Often found incidentally on MRI or CT requested for foot pain.

Causes & Risk Factors

Congenital failure of bone segmentation Autosomal dominant inheritance pattern Family history of flat feet or foot stiffness Bilateral in up to 50–60% of cases Associated with other foot anomalies Symptoms triggered by increased activity or growth spurts Ossification typically complete by age 12–16

Symptoms

Signs & Symptoms of Tarsal Coalition

How It Presents

Hindfoot or midfoot pain, often deep and diffuse Progressive rigid or semi-rigid flatfoot deformity Stiffness and reduced subtalar joint movement Recurrent lateral ankle sprains Peroneal muscle spasm — foot held in eversion Pain worsening with activity, sport or prolonged standing Fatigue and aching after walking or running

The Age Pattern

Symptoms typically emerge during late childhood and adolescence as the coalition ossifies and the foot loses its compensatory flexibility. Many patients describe a gradual onset of foot and ankle pain around age 10–16, often initially attributed to growing pains or sports injuries.

A key clinical sign is restricted or absent subtalar joint movement combined with a rigid flatfoot — the inability to form an arch when standing on tiptoe is a classic finding. Peroneal spasm, producing a characteristic valgus posture of the hindfoot, is particularly associated with talocalcaneal coalition.

Many adults carry an undiagnosed coalition for years before it is identified, often after an imaging investigation for another reason.

Differential diagnosis

Conditions That Can Feel Similar

Several conditions cause hindfoot pain, flat feet and ankle instability in children and young adults. Accurate diagnosis — ideally with CT or MRI — is essential before embarking on treatment.

Flexible Flatfoot

A common and usually asymptomatic condition in children where the arch is present when non-weight-bearing but collapses on standing. Unlike tarsal coalition, the subtalar joint is fully mobile, the heel rises and an arch forms on tiptoe. No bony bar is present on imaging.

Juvenile Idiopathic Arthritis

Inflammatory arthritis affecting the foot and ankle joints in children can produce stiffness, pain and a valgus hindfoot similar to coalition. Distinguished by symmetrical joint involvement, elevated inflammatory markers, synovitis on MRI, and the absence of a bony or fibrous bar on CT.

Recurrent Ankle Sprain

Tarsal coalition is a recognised but under-appreciated cause of recurrent ankle sprains in adolescents. The restricted subtalar motion shifts stress onto the lateral ankle ligaments. If a young patient keeps spraining the same ankle despite rehabilitation, coalition should be investigated.

Accessory Navicular

An extra bone on the medial side of the navicular causing medial arch pain and sometimes a prominent bump. Can occur alongside a flat foot deformity but is a distinct structure from tarsal coalition, visible on plain X-ray, and responds to different management.

Treatment

Our Approach to Treating Tarsal Coalition

The majority of tarsal coalition cases — particularly those that are fibrous or cartilaginous, or where symptoms are mild to moderate — respond well to conservative management. The goal is to reduce pain, support foot mechanics and maintain function. Surgery is reserved for those who have not responded to a thorough course of conservative care. Our approach is always personalised to the type of coalition, the severity of symptoms, the patient's age and their activity goals.

Accurate Diagnosis & Imaging

Clinical assessment including subtalar joint range of motion, tiptoe test, peroneal muscle assessment and hindfoot alignment. Plain X-ray can identify calcaneonavicular coalition and show the classic "C-sign" of talocalcaneal coalition. CT provides the most accurate assessment of osseous coalition extent; MRI is best for fibrous and cartilaginous coalitions and surrounding soft tissue. We will request appropriate imaging where needed.

Custom Orthotics

The cornerstone of conservative management for tarsal coalition. Custom orthotics support the medial arch, reduce stress on the coalition site, offload the subtalar joint and correct the associated flatfoot deformity. Prescribed following treadmill gait analysis with Onform joint tracking to ensure the prescription addresses the specific mechanics of each patient's foot.

Activity Modification & Load Management

Reducing high-impact activities and modifying training load during symptomatic periods allows inflammation at the coalition site to settle. We provide a structured plan for graded return to activity that maintains fitness while protecting the foot — particularly important for young athletes.

Immobilisation (Acute Flare-ups)

During acute symptomatic episodes — particularly in younger patients — a short period of immobilisation in a walking boot or below-knee cast can significantly reduce pain and allow the coalition site to settle. This is typically followed by a gradual return to activity with orthotic support.

Strengthening & Rehabilitation

Targeted exercises to strengthen the intrinsic foot muscles, peroneal group and lower limb stabilisers improve dynamic support around the restricted hindfoot joints. Proprioceptive training reduces the recurrent ankle sprain risk that is commonly associated with tarsal coalition.

Corticosteroid Injection

A targeted steroid injection into the subtalar joint or around the coalition site can reduce pain and inflammation in cases with significant synovitis or where conservative measures alone are insufficient. Used selectively as part of a broader management plan. See our injection therapy page for more information.

Surgical Referral (If Required)

Where conservative management fails to provide adequate relief, surgical options include resection of the coalition (bar resection) — which can restore motion and is most successful in younger patients with fibrous or cartilaginous coalitions — or subtalar fusion for more advanced osseous coalitions with significant joint degeneration. We refer to trusted orthopaedic and podiatric surgeons and coordinate pre- and post-operative care.

Why us

Why Patients Choose The Functional Podiatrist

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Accurate diagnosis & imaging guidanceWe identify the coalition type and extent and request appropriate CT or MRI to guide management — not a one-size approach.

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Treadmill gait analysis with OnformIdentifying the specific flatfoot mechanics and subtalar restriction to prescribe orthotics that genuinely address the underlying biomechanics.

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Experience with adolescent foot conditionsTarsal coalition is primarily a condition of young people — we understand growth-related presentations and age-appropriate treatment planning.

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Injection therapy availableTargeted corticosteroid injections for cases with significant subtalar joint inflammation.

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Surgical referral networkCoordinated referral for bar resection or subtalar fusion if conservative management is insufficient.

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HCPC-registered podiatristsRichmond (TW9) and Kensington (W8) — no GP referral needed.

FAQs

Common Questions About Tarsal Coalition

Can tarsal coalition be treated without surgery?

Yes — the majority of cases, particularly those that are fibrous or cartilaginous and where symptoms are mild to moderate, respond well to conservative management with orthotics, activity modification and rehabilitation. Surgery is reserved for patients who have not improved after a thorough course of conservative treatment, or where the coalition is osseous and associated with significant joint degeneration.

At what age does tarsal coalition become symptomatic?

Symptoms most commonly emerge between the ages of 8 and 16 as the coalition ossifies and the foot loses its ability to compensate for the restricted motion. Calcaneonavicular coalitions tend to become symptomatic earlier (around 8–12 years) and talocalcaneal coalitions slightly later (12–16 years). Many adults carry an undiagnosed coalition that was never identified in childhood.

Will my child need surgery?

Most children with tarsal coalition do not require surgery. Conservative management with orthotics, load modification and rehabilitation is effective in the majority of cases. Surgery is considered only when conservative treatment has been given a genuine trial and symptoms remain significantly limiting. The decision depends on the type of coalition, its extent, the degree of any joint degeneration and the patient's age.

Does tarsal coalition run in families?

Yes — tarsal coalition has an autosomal dominant inheritance pattern, meaning it tends to run in families. If one parent has a coalition, there is a significant chance that a child may also be affected. It is bilateral in up to 50–60% of cases, so if a coalition is found on one side, the other foot should be assessed.

Can tarsal coalition cause flat feet?

Yes — tarsal coalition, particularly talocalcaneal coalition, is a common structural cause of a rigid or semi-rigid flatfoot deformity. The restricted subtalar motion prevents the normal arch-forming mechanism of the foot. Unlike flexible flat feet — which are usually asymptomatic and do not require treatment — the flatfoot associated with coalition tends to be painful and progressively rigid.

Is treatment covered by health insurance?

Yes — podiatry consultations are typically covered by most major insurers. We work with Bupa, Aviva, WPA and others. See our insurance page for full details.

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