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Tarsal Coalition (Rigid Flatfoot in Children)
Tarsal coalition is an abnormal bony, cartilaginous, or fibrous connection between two or more of the tarsal bones (foot bones) - present from birth but typically becomes painful during adolescence (ages 8-16) when the coalition ossifies and restricts foot motion - it causes rigid flatfoot, ankle pain, recurrent sprains, and muscle spasms (peroneal spasm) - conservative treatment (custom orthotics, activity modification, short-leg walking cast) provides symptom relief in 50-60% of patients, while persistent symptoms are treated with surgery to remove the coalition (resection) achieving 70-80% good outcomes in well-selected cases.
đWhat is Tarsal Coalition (Rigid Flatfoot in Children)?
Tarsal coalition is an abnormal bony, cartilaginous, or fibrous connection between two or more of the tarsal bones (foot bones) - present from birth but typically becomes painful during adolescence (ages 8-16) when the coalition ossifies and restricts foot motion - it causes rigid flatfoot, ankle pain, recurrent sprains, and muscle spasms (peroneal spasm) - conservative treatment (custom orthotics, activity modification, short-leg walking cast) provides symptom relief in 50-60% of patients, while persistent symptoms are treated with surgery to remove the coalition (resection) achieving 70-80% good outcomes in well-selected cases.
đŦWhat Causes It?
- Congenital condition (present from birth due to failure of tarsal bones to separate during fetal development)
- Genetic predisposition (family history in 40-50% of cases, often bilateral)
- Ossification of coalition during adolescence (ages 8-16) triggering symptoms
- Trauma or infection accelerating fusion (rare secondary causes)
- Unknown developmental abnormality affecting foot bone formation
â ī¸Risk Factors
You may be at higher risk if:
- Family history of tarsal coalition (genetic component)
- Bilateral involvement (50-60% have coalitions in both feet)
- Age 8-16 years (symptom onset when coalition ossifies)
- Increasing activity level in adolescence exposing previously asymptomatic coalition
- No clear modifiable risk factors (congenital condition)
đĄī¸Prevention
- âCannot prevent congenital tarsal coalition (present from birth)
- âEarly diagnosis and treatment prevents progression to arthritis
- âCustom orthotics may delay or prevent symptom development in asymptomatic coalitions
- âAvoid high-impact sports if coalition identified to reduce arthritis risk
- âFamily screening: if one child has coalition, siblings may benefit from examination