Tarsal Coalitions in Adults

NewsBot · Jul 19, 2012

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Tarsal coalitions in the adult population: does treatment differ from the adolescent?
Thorpe SW, Wukich DK.
Foot Ankle Clin. 2012 Jun;17(2):195-204

There is a paucity of information on adult coalitions without large, well-designed outcome studies. Current recommendations are thus similar to those for adolescents. Based on the available literature, current recommendations include an initial trial of adequate nonoperative treatment in symptomatic coalitions. Unlike adolescent coalitions, nonoperative treatment may be even more effective in the adult patient as many are asymptomatic or discovered after injury. If nonoperative treatment fails, then surgical intervention is considered and tailored to the location of the coalition, existing advanced arthrosis, and any existing deformity. Similar to the adolescent, surgical treatment for adult calcaneonavicular coalitions typically involves an attempt at resection with some type of interposition. Resection can be attempted for talocalcaneal coalitions that do not present with advanced arthrosis or significant hindfoot malalignment. For those patients with advanced arthrosis, more than 50% involvement of the joint hindfoot malalignment, subtalar or triple arthrodesis is recommended. The decision between resection and arthrodesis is controversial in the adolescent population. With few outcome studies in adults, it is even more difficult to make definitive treatment recommendations; however, the indications for resection are likely even more limited. It is likely that the adult subtalar coalition that becomes symptomatic and fails nonoperative treatment will require arthrodesis for full pain relief and improvement in objective outcome measures, such as the AOFAS hindfoot score. Our treatment algorithm focuses first on a trial of nonoperative treatment of at least 3 months regardless of coalition location. After failed nonoperative treatment, calcaneonavicular coalitions are in most cases treated with excision and interpositional fat graft. For talocalcaneal coalitions, resection is offered to patients with neutral hindfoot alignment, some preservation of subtalar joint motion and no adjacent joint arthrosis. The patients are advised that the outcome after resection of talocalcaneal coalitions is less predictable than resection of calcaneonavicular coalitions. Those patients with absent subtalar motion and relatively normal hindfoot alignment are candidates for in situ fusion of the subtalar joint. For those patients with greater than 15° of valgus hindfoot malalignment on a weight-bearing hindfoot alignment view or adjacent joint arthrosis, a triple arthrodesis is recommended with or without medial displacement osteotomy of the calcaneus. Adjacent joint arthrosis may be determined by radiographs, CT scan, or preoperative MRI.
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NewsBot · Jul 19, 2012

Related threads:
Talocalcaneal coalition
Tarsal coalitions in homind fossils
Calcaneonavicular coalition
Navicular-medial cuneiform tarsal coalition
Foot orthoses for tarsal coalition
TLAP = "too long" anterior process of calcaneus
Other threads tagged with tarsal coalition

NewsBot · Aug 14, 2013

Tarsal Coalitions: A Review and Assessment of the Incidence in the Amish Population
Mark Mendeszoon DPM, Ewald Mendeszoon DPM, Susan pdflrgOrabovic DPM, Corey Valentine DPM
The Foot and Ankle Online Journal 6 (7): 1

Objective: The incidence of tarsal coalitions in the general population is not clear; it is supported that there is a genetic component to the congenital form of tarsal coalitions. Although, there have been no known studies on the Amish, it is believed that the Amish have a greater percentage of coalitions due to their restricted gene pool. This study was performed to show that there is an increase of tarsal coalitions in the Amish community.
Materials and Methods: This was a 10-year study of 33 Amish patients with tarsal coalitions involving the talo-calcaneal, calcaneo-navicular, and talo-navicular coalitions. A total of 38 cases were reviewed.
Results: Of the 38 total cases reviewed, 29 of the 38 involved the talo-calcaneal joint, a 76.3% incidence of the talo-calcaneal coalition. The calcaneo-navicular joint was involved in 8 of the 38 cases, or a 21% incidence. Only 1 patient, a 2.6% incidence, was reported to have a talo-navicular coalition. More males were affected with coalitions with overall male to female ratio of 18:11 respectively. There were several bilateral cases noted, with more calcaneo-navicular cases noted to be bilateral than any other type of coalition. It was noted to be a 25% incidence.
Discussion: The results in this study suggest that tarsal coalitions are indeed inherited, likely as a multi-factorial disorder of autosomal dominant inheritance. From these results, tarsal coalitions are not as rare of a phenomenon as previously believed especially in the Amish community.
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NewsBot · Feb 16, 2014

Tarsal Coalitions: Radiographic, CT, and MR Imaging Findings
David A. Lawrence MD, Michael F. Rolen MD, Andrew H. Haims MD, Zakaria Zayour MD, Hicham A. Moukaddam MD
HSS Journal ®; February 2014

Background
Tarsal coalitions affect up to 13% of the population and can be a cause of chronic ankle and hindfoot pain. They can be subdivided as osseous, cartilaginous, or fibrous types, each with unique radiographic, CT, and MR imaging findings. In particular, MR imaging offers the unique ability to determine the exact type of tarsal coalition that is present as well as whether any associated soft tissue abnormalities are present.
Questions/Purposes
The purposes of this paper were to (1) review the anatomy of the hindfoot; (2) review the radiographic, CT, and MR imaging findings of tarsal coalitions; and (3) review the imaging appearance of the specific types of tarsal coalitions.
Methods
Online searches were performed using Google Scholar with the search criteria of “tarsal coalition,” “hindfoot anatomy,” and “subtalar coalition,” and limiting the searches to papers published in the last 10 years in major radiology journals.
Results
The anatomy of the hindfoot is complex but essential to understand. There are various radiographic, CT, and MR imaging findings that can be consistently noted in cases of tarsal coalition. The specific types of tarsal coalition demonstrate characteristic imaging findings.
Conclusions
Knowledge of the normal anatomy of the foot, in particular the hindfoot, combined with the knowledge of the imaging characteristics of different histologic subtypes of coalitions (osseous, cartilaginous, and fibrous) is essential for interpreting radiographic, CT, and MR images of the ankle and foot.
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NewsBot · Jul 8, 2014

Reoperations after Tarsal Coalition Resection: A Population-based Study
Amir Khoshbin, MDemail address, Maryse Bouchard, MD, MSc, FRCSC, David Wasserstein, MD, MSc, FRCSC, Timothy Leroux, MD, Peggy W. Law, MSc, Hans J. Kreder, MD, MPH, FRCSC, Timothy R. Daniels, MD, FRCSC, James G. Wright, MD, MPH, FRCSC
Journal of Foot and Ankle Surgery Article in Press

Few studies have evaluated the incidence of subsequent operations after tarsal coalition resection. Using administrative databases, we followed up a cohort of patients who had undergone tarsal coalition resection to determine the rates and possible risk factors for subsequent resection or arthrodesis. Patients (aged 8 years or older) who had been treated from July 1994 to August 2009 in Canada were identified and included. Those with nonidiopathic coalitions were excluded. The time-to-event data for the earliest subsequent procedure were fit to a Cox proportional hazards model that evaluated the patient, operative, and provider factors. Controlling for covariates, the hazard ratios were computed; however, the laterality of any subsequent operation could not be confirmed. A total of 304 patients underwent tarsal coalition resection at an average age of 24.2 ± 17.5 years. Of these 304 patients, 26 (8.6%) underwent subsequent resection and 16 (5.3%) mid- or hindfoot arthrodesis. Of all the factors, the need for future fusion was more likely only if the primary resection had been performed at an academic hospital or if the patient had undergone concomitant arthrodesis at primary resection of the coalition (hazard ratio 3.0, 95% confidence interval 1.1 to 8.5; and hazard ratio 9.7, 95% confidence interval 1.7 to 56.1, respectively). The incidence of reoperation after primary tarsal coalition resection was low in our cohort. More than 85% of our patients never required additional operative intervention an average of 9 years after the initial resection. Our data also suggest that primary treatment of tarsal coalition with resection and concomitant arthrodesis increases the risk of requiring a second fusion in the future.
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NewsBot · Aug 17, 2014

Isolated Fifth Metatarsocuboid Coalition: A Case Report
Hayato Kobayashi, MD, PhDemail, Yasunori Kageyama, MD, PhD, Yoji Shido, MD, PhD
The Journal of Foot and Ankle Surgery Articles in Press

Isolated tarsometatarsal coalitions are extremely rare, and the previous 5 documented cases involved the first and third metatarsocuneiform joints. We report the case of a 69-year-old female with symptomatic fifth metatarsocuboid coalition associated with ipsilateral varus-type ankle osteoarthritis and instability. The patient was successfully treated by arthrodesis of the fifth metatarsocuboid joint, resection of the hypertrophied tuberosity of the fifth metatarsal, advancement of the peroneus brevis tendon, opening wedge distal tibial osteotomy, and calcaneal displacement osteotomy. After 1 year, 6 months, she was able to walk well, although she complained of minor discomfort under the fifth metatarsal base, which resolved with the use of protective padding. Radiographs at this stage confirmed consolidation of both the arthrodesis and the osteotomy sites. Although isolated fifth metatarsocuboid coalition is less likely to be encountered than other tarsal coalitions, it can sometimes be painful enough to necessitate surgery.
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NewsBot · Sep 21, 2015

Nonosseous Tarsal Coalition of the Lateral Cuneocuboid Joint: A Case Report
Kan Imai, MD, PhD, Kazuya Ikoma, MD, PhDcorrespondenceemail, Masamitsu Kido, MD, PhD, Masahiro Maki, MD, PhD, Yuji Arai, MD, PhD, Hiroyoshi Fujiwara, MD, PhD, Toshikazu Kubo, MD, PhD
JFAS; Article in Press

We describe a rare case of a nonosseous coalition of the lateral cuneocuboid joint with peroneal spasm that we successfully treated with resection. A 60-year-old female had been experiencing constant pain in her right foot, particularly when walking and going up and down stairs. The pain had been present for approximately 1 year after she had experienced a minor injury. Her right ankle showed plantar flexion restrictions (right 20? and left 40?) and was held in an antalgic valgus position. Sudden passive plantar flexion produced pain behind the lateral malleolus of the right ankle. Tenderness was detected in the right peroneus brevis tendon and the right sinus tarsi. On plain radiographs, the oblique view showed an irregularity in the articular surface of the lateral cuneocuboid joint in both feet. On computed tomography images, there was no osseous continuation in the lateral cuneocuboid joint, indicative of a nonosseous bridge between the lateral cuneiform and the cuboid. The nonosseous coalition between the lateral cuneiform and the cuboid was resected and the trabecular surfaces and cortical margins covered with a thin film of bone wax. The patient's recovery was unremarkable, and 1 year after surgery, she was able to walk without pain and was able to perform her usual activities and job.
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NewsBot · Nov 15, 2017

The Rare Lateral Cuneo-Cuboid Coalition: A Case Report.
Kevin Renner, Eric so, Amanda Quisno, and Daniel Logan
Journal of the American Podiatric Medical Association In-Press.

BACKGROUND:Tarsal coalitions typically occur at the talocalcaneal or calcaneonavicular joints. Common findings are pain, limited range of motion, and a pes planus deformity.

METHODS:The focus of this case report will include the presentation, imaging, treatment, and outcomes for a 21-year-old female diagnosed with a rare lateral cuneo-cuboid coalition with chronic pain. Clinical and radiographic examinations, typically utilized to diagnose the common coalition, were unremarkable. An MRI was diagnostic of the lateral cuneo-cuboid coalition and was successfully treated with surgical resection.

RESULTS:At 6-year follow-up, she reports resolution of symptoms and has returned to her normal pre-surgical activity level pain-free.

CONCLUSIONS: This case is only the third lateral cuneo-cuboid coalition reported in the literature. The rarity of this coalition and unsuspecting clinical presentation makes it worthy of acknowledgement.
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NewsBot · Jul 20, 2018

Results of Nonoperative Treatment for Symptomatic Tarsal Coalitions.
Shirley E, Gheorghe R, Neal K M
Cureus 10(7): e2944. doi:10.7759/cureus.2944

Introduction: Recommendations for the initial treatment (nonoperative measures to surgical excision) of symptomatic tarsal coalitions vary. Because nonoperative outcomes are poorly established, we retrospectively evaluated their success in preventing surgery and achieving pain relief for pediatric patients with symptomatic tarsal coalitions.

Materials and methods: A retrospective study of pediatric patients with symptomatic tarsal coalitions treated at a single institution was undertaken. Clinical notes were examined for treatment methods, response to treatment, and need for additional procedures. A statistical analysis was performed using the chi-square and Mann-Whitney U tests.

Results: Fifty symptomatic tarsal coalitions (mean patient age, 11.4 years; range, 8.1–17.9) were treated with nonoperative measures. Surgery was not required in 79% of calcaneonavicular and 62% of talocalcaneal coalitions. Pain relief was achieved in 53% of 81 nonoperative treatment trials. Continuous immobilization via casting, intermittent immobilization via walking boot, and supportive measures were not significantly different in pain relief (p = 0.35) or preventing surgery (p = 0.62).

Conclusion: Nonoperative treatment methods have the potential to achieve pain relief and prevent or delay surgery for symptomatic tarsal coalitions. However, some families may elect to forgo nonoperative measures knowing that surgery may eventually be required.
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NewsBot · Nov 26, 2018

Treatment of isolated
talonavicular coalition:
Case report and
literature review
Xiaojun Duan and Liu Yang
Journal of International Medical Research

Tarsal coalition refers to an abnormal fibrous, cartilaginous, or bony connection that develops
between two or more tarsal bones. Talocalcaneal coalition and calcaneonavicular coalition
account for more than 90% of all cases of tarsal coalition. Coalition exists early at birth, but
bony connection usually develops during the patient’s late growth period. Isolated cases
of talonavicular coalition have rarely been reported. We herein report a case involving an
11-year-old patient with an isolated talonavicular coalition from a soft tissue to bony connection
who was treated with arthroscopy for ankle arthritis. To our knowledge, this is the first case in
which the whole formation of the talonavicular coalition was observed with a series of radiographic
and magnetic resonance imaging examinations. The pain caused by the talonavicular
coalition was managed by nonoperative treatment, while the ankle pain caused by the arthritis
was relieved after ankle arthroscopy. At 6 years postoperatively, the patient remained pain-free
while walking for 30 minutes and was satisfied with the operative outcome. Continuous follow-up
confirmed that after the formation of talonavicular coalition, the coalition can continue to progress,
forming bony talocalcaneal coalition and calcaneocuboid coalition.
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NewsBot · Aug 6, 2020

Endoscopic Resection of Tarsal Coalitions
Andrew King, Stephen Parsons
Foot Ankle Clin. 2020 Sep;25(3):493-503

Endoscopic resection of tarsal coalitions is technically feasible for both talocalcaneal and calcaneonavicular coalitions. Careful consideration of each individual patient is necessary before proceeding with endoscopic resection. Endoscopic resection of these coalitions may offer benefits in terms of faster recovery and less wound problems, but this has not been proven. Several case reports and case series appear in the literature and are reviewed here along with the different techniques reported. Better-quality evidence is required to assess the clinically relevant benefits and the recurrence rate for endoscopic resection in comparison with open resection.
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NewsBot · Nov 22, 2020

Incidence of Symptomatic Pediatric Tarsal Coalition in Olmsted County: A Population-Based Study
Taylor J Jackson, A Noelle Larson, Smitha E Mathew, Todd A Milbrandt
J Bone Joint Surg Am. 2020 Nov 11

Background: Tarsal coalitions are an important reason for foot pain in children. Early estimates placed the prevalence at up to 2%, while more recent data suggest that it is as high as 11% to 13%. To our knowledge, there have been no population-based studies to determine the true incidence of symptomatic tarsal coalitions in a pediatric population.

Methods: A population-based database was used to identify all new diagnoses of symptomatic tarsal coalitions in children 18 years old or younger between 1966 and 2018. Patient records were reviewed for clinical data, and comparisons were made between the types and characteristics of the coalitions identified to determine differences in the affected populations. The annual age-specific, sex-specific, and type-specific incidence rates were estimated.

Results: During the study period, 58 patients with a total of 79 symptomatic tarsal coalitions were identified (annual incidence = 3.5 per 100,000 children). There were 43 calcaneonavicular (CN) coalitions (annual incidence = 1.9 per 100,000 children), 27 talocalcaneal (TC) coalitions (annual incidence = 1.2 per 100,000 children), as well as 9 other coalitions (7 talonavicular, 1 naviculocuboid, and 1 naviculocuneiform) (annual incidence = 0.4 per 100,000 children). The overall incidence peaked between the ages of 10 and 14 years for both boys and girls (8.1 per 100,000 and 7.4 per 100,000 children, respectively). Statistical differences were identified between the types of tarsal coalitions. TC coalitions present at an older age relative to CN and other coalitions (mean,13.9, 12.7, and 11.4 years, respectively; p = 0.02). While CN and TC coalitions were similar in composition (23% and 30%, respectively, were osseous as opposed to fibrocartilaginous), other coalitions were more likely to be osseous (78%) (p = 0.0035). Other coalitions were also less likely to require surgery than CN and TC coalitions (11%, 74%, and 56%, respectively; p = 0.0015).

Conclusions: This population-based study demonstrates differences in the clinical presentation of tarsal coalitions and provides an estimate of the true incidence of symptomatic tarsal coalitions in a pediatric population.
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NewsBot · Feb 22, 2022

Multiple Tarsometatarsal Coalitions: A Case Report.
Bashir A, Hamid M A, Parry M A
Cureus 14(2): e22358. doi:10.7759/cureus.22358

Tarsometatarsal coalitions have rarely been reported in published literature. The few reported cases presented with varying degrees of pain. Here, we describe the case of a 16-year-old female with multiple tarsometatarsal coalitions, the first of its kind in the reported literature. Descriptions in anthropology literature suggest that these lesions might be more common than previously thought and, in some circumstances, can become symptomatic enough to warrant intervention.
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NewsBot · Mar 28, 2022

8 out of 10 Patients Do Well After Surgery for Tarsal Coalitions: A Systematic Review on 1284 Coalitions
Julian J.Hollander et al
Foot and Ankle Surgery 24 March 2022

Background
The primary aim was to determine the clinical success rate after treatment for talocalcaneal (TCC) and calcaneonavicular coalitions (CNC). The secondary aim was to evaluate the complication, recurrence and revision rate.

Methods
A search was carried out in MEDLINE, EMBASE and Cochrane Library. Methodological quality was assessed using the Methodological Index for Non-Randomised Studies (MINORS) criteria. The primary outcome was the clinical success rate and was pooled per type of coalition and treatment modality. 95% Confidence Intervals (CI) of the success rates were calculated. Secondary outcomes included complication rates, coalition recurrence rates, revision rates and pain improvement using the Visual Analogue Scale (VAS). A sub-analysis on interposition material was performed.

Results
43 articles comprising of 1284 coalitions were included, with a pooled mean follow-up of 51 months. Methodological quality was fair. The overall pooled success rate for TCCs was 79% (95% CI, 75%-83%). Conservative treatment, open resection and arthroscopic resection of TCCs resulted in success rates of 58% (95% CI, 42%-73%), 80% (95% CI, 76%-84%) and 86% (95% CI, 71%-94%), respectively. CNCs have an overall success rate of 81% (95% CI, 75%-85%), with 100% (95% CI, 34%-100%), 80% (95% CI, 74%-85%) and 100% (95% CI, 65%-100%) for conservative treatment, open resection and arthroscopic resection, respectively. Pooled complication rates of 4% (95% CI, 3%-7%) for TCCs and 6% (95% CI, 4%-11%) for CNCs were found. The success rates of resection with and without interposition material for TCCs were 83% (95% CI, 78%-87%) and 79% (95% CI, 65%-88%), and for CNCs 81% (95% CI, 76%-86%) and 69% (95% CI, 44%-85%), respectively.

Conclusion
Treatment of tarsal coalitions can be considered good to excellent as well as safe, with an overall clinical success rate of 79% for TCCs and 81% for CNCs. Arthroscopic resection of the coalition appears to be non-inferior to open resection of TCCs and CNCs.
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NewsBot · Apr 5, 2022

Multiple Tarsometatarsal Coalitions: A Case Report
Arshad Bashir et al
Cureus. 2022 Feb 18;14(2):e22358

Tarsometatarsal coalitions have rarely been reported in published literature. The few reported cases presented with varying degrees of pain. Here, we describe the case of a 16-year-old female with multiple tarsometatarsal coalitions, the first of its kind in the reported literature. Descriptions in anthropology literature suggest that these lesions might be more common than previously thought and, in some circumstances, can become symptomatic enough to warrant intervention.
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NewsBot · Apr 11, 2022

A retrospective magnetic resonance imaging analysis of bone and soft tissue changes associated with the spectrum of tarsal coalitions
Atilla Hikmet Cilengir,Ezgi Suat Bayraktar,Suat Dursun,Mehmet Ozdemir,Sedat Altay,Ferhan Elmali,Ozgur Tosun
06 April 2022

We aimed to investigate the bone and soft tissue changes accompanying tarsal coalition (TC) and aimed to evaluate their association with the location and type of coalition. Ankle magnetic resonance imagings of 65 patients with TC were included. The relationship between the location and type of coalition and bone marrow edema, subchondral cysts, sinus tarsi syndrome, tarsal tunnel syndrome, posterior impingement syndrome, accessory bone, tibiotalar effusion, talar osteochondritis dissecans, ganglion cysts, and calcaneal spur were evaluated. Twenty-nine patients without coalition were selected as the control group, and the distribution of these variables between the two groups was analyzed. There were 33 females and 32 males in the coalition group (mean age: 42.0 ± 15.63 years), and 22 females and seven males in the control group (mean age: 44.79 ± 12.33 years). Coalition was most common in the talocalcaneal joint (n = 33, 50.8%), and the most common coalition type was non-osseous (n = 57, 87.6%). We find no significant difference between the pathologies defined in terms of coalition location and type. Sinus tarsi syndrome, tarsal tunnel syndrome, subchondral cysts, and tibiotalar effusion were found to be more common in the coalition group (p = 0.028, p = 0.010, p = 0.023, and p = 0.006, respectively). The presence of coalition increased the probability of developing tarsal tunnel syndrome 9.91 times (95% CI: [1.25–78.59]; p = 0.029), and sinus tarsi syndrome 3.66 times (95% CI: [1.14–11.78]; p = 0.029). Tarsal coalition may predispose bone and soft tissue changes. In this study, sinus tarsi syndrome, tarsal tunnel syndrome, subchondral cysts and tibiotalar effusion were found to be more common in the coalition group.
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NewsBot · May 30, 2022

Prevalence and characteristics of tarsal coalition in
East Asians: what are the differences compared to
Caucasians?
Jeong Jin Park et al
Research Square

Background
Previous studies have reported a prevalence of tarsal coalition of 1–2%. Calcaneonavicular coalition is
known as main anatomical type. The bilateral occurrence of tarsal coalition is known to be 50–60%.
These are the results of studies on Caucasians, there have been few studies targeting large number of
East Asians so far. Also, there are not many analyzes of tarsal coalition on both feet especially in East
Asia. This study was performed to evaluate the prevalence and characteristics of tarsal coalition in the
Korean population using both-side computed tomography. We hypothesized that the prevalence and
characteristics of tarsal coalition in East Asians might differ from previously reported results from
Caucasians.
Methods
The medical records of 839 patients who underwent bilateral computed tomography on foot and ankle in
our hospital from January 2012 to April 2021 were reviewed. Fifty received a diagnosis of tarsal coalition.
The overall prevalence of tarsal coalition and proportions of tarsal coalition patients by gender and age
were assessed. Anatomical types of tarsal coalition were classified according to union locations and
bilateral occurrence was evaluated for each anatomical type. In addition, proportions of symptomatic
patients associated with tarsal coalition were evaluated by anatomical type.
Results
The overall prevalence of tarsal coalition among the 839 patients was 6.0%. Isolated talocalcaneal
coalition was the most common anatomical type (50.0%). Bilateral occurrence was observed in 56.5% of
those with tarsal coalition, talocalcaneal coalition had the highest bilateral occurrence (76.0%). Isolated
union of the posterior facet was the most common subtype of talocalcaneal coalition (43.2%).
Talocalcaneal coalition had a significantly higher proportion of symptomatic patients associated with
tarsal coalition than calcaneonavicular coalition (p = 0.019).
Conclusion
The prevalence of tarsal coalition was found to be 6%. Talocalcaneal coalition was the most common,
and most talocalcaneal coalitions involved the posterior facet. Talocalcaneal coalition was significantly
more associated than CN coalition with bilaterality and coalition related symptoms. The possibility of
tarsal coalition in foot and ankle patients in East Asians should always be considered, and bilateral
examination is essential for diagnosis
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NewsBot · Jun 8, 2022

Retrospective Comparison of Tarsal Coalition Resection versus
Arthrodesis
Alex Dang, B.S., Rahul Natarajan, B.S., and Nathan Fischer, B.A.
Extremitus

Objective: The purpose of this study is to compare and contrast the efficacy of resection versus arthrodesis for the
treatment of tarsal coalitions.
Methods: A search on relevant research pertaining to tarsal coalition resection and arthrodesis was reviewed via the
PubMed, National Institute of Health, and ScienceDirect databases. Articles were reviewed for each method of
treatment due to a lack of direct comparison in literature.
Results: In studies observed, the surgical resection was recommended over arthrodesis for primary treatment of tarsal
coalitions in the pediatric population. Arthrodesis provides higher revision rates and risks of complications that are
not viable in pediatric patients. Growth plates are disturbed, and joint fusion would not provide good quality of life
for the patient post op. Thus, the research indicates that resection should be used as the primary form of treatment for
congenital tarsal coalitions with arthrodesis as a salvage procedure to be performed if resection fails.
Conclusion: The majority of research suggests that surgical resection is a better form of primary treatment when
compared to arthrodesis. Multiple surgeries are not ideal for the pediatric population. It is intuitive that arthrodesis has
higher rates of complications due to the fusion of joints in a growing adolescent. Based on the patient population and
risk of complications with revisional surgery, resection is the ideal form of treatment for tarsal coalitions, with
arthrodesis only being viable if needed.
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NewsBot · Aug 9, 2022

Bilateral Tarsal Coalitions: Are Postoperative Outcomes Different From Unilateral?
Mahan, S. T., Miller, P. E., May, C., Kasser, J. R., & Spencer, S. A.
JPOSNA®, 4(3)

Purpose: The purpose of this prospective study was to assess and compare clinical outcomes for patients with bilateral tarsal coalitions who had at least one coalition treated with surgical excision.

Method: Patients were identified prospectively and agreed to participate. Data was collected prior to surgery, and again after surgery for up to 2 years. Comparisons of patients with unilateral disease to bilateral disease as well as unilateral excision to bilateral staggered and bilateral concomitant excision was done.

Results: Initial cohort included 55 patients with 70 feet containing a tarsal coalition. 30 patients with 45 feet had bilateral tarsal coalition excision during the study period. Post-operative outcomes were considerably improved from preoperative outcomes. Five bilateral patients had concomitant excision, and ten had staggered surgery. There was no difference in outcome from patients with unilateral disease when compared to bilateral disease. There was no difference in patients with bilateral disease who had only one side excised compared to those that had both sides excised, and there was no difference in outcome for patients with staggered surgery compared to those with concomitant surgery.

Conclusions: Patients with bilateral tarsal coalition show improvement in their outcomes in a similar fashion to those with unilateral disease. Concomitant surgical outcomes are comparable to staggered outcomes in this group, although the series is small.
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NewsBot · Nov 17, 2022

Tarsal Coalition is Not Necessarily Associated with a Flatfoot Deformity: A Cohort of Clinically
Misdiagnosed Cases and Alignment Features in 41 Feet
Jeremy Ansah-Twum, BS; Mingjie Zhu, DAOM, MPH; Melissa L. Carpenter, BS; Sera Sempson, BS; Kenneth J. Hunt, MD;
Mark S. Myerson, MD; Shuyuan Li, MD, PhD
AOFAS Annual Meeting 2022

Introduction/Purpose: Tarsal coalition has been historically reported to be associated with a flatfoot deformity. There are
however case reports demonstrating that it can be found in cavovarus and clubfoot deformities. The goal of this study was to
retrospectively review all weightbearing CT (WBCT) scans that were taken in one medical center, to investigate the clinically
diagnosed as well as missed cases of tarsal coalition, and to determine the hindfoot alignment and arch height features of each
case.
Methods: 800 WBCT scans were reviewed separately by two senior fellowship trained foot and ankle surgeons. The structure of
the hindfoot and midfoot was carefully examined in all three views to screen for different types of tarsal coalition. For cases that
were diagnosed with tarsal coalition on WBCT, the medical charts were then reviewed to determine the original clinical
diagnoses. Hindfoot alignment and arch height features of the midfoot were subsequently evaluated on WBCT scans.
Results: There were 41 feet that were diagnosed with tarsal coalition on WBCT (Figure 1). The clinical diagnosis of coalition was
only made in 15 feet and 26 symptomatic feet were clinically missed. Among the 26 symptomatic feet diagnosed on WBCT but
clinically missed, 16 had a clinical diagnosis of congenital or acquired flatfoot, 3 with subtalar arthritis, 1 with talonavicular arthritis,
1 with peroneal tendinopathy and a cavovarus foot deformity, 2 with cavovarus deformity and midfoot arthritis, 2 with
posttraumatic ankle arthritis, and 1 with subtalar impingement. A valgus hindfoot was found in 19 feet, a neutral hindfoot in 18,
and a varus hindfoot in 4 feet. In the midfoot, 38 feet had a positive (>=1) distal medial cuneiform/fifth metatarsal arch height
index, and 3 feet had a negative index (<1); all 41 feet had a positive proximal cuneiform/cuboid height index (>=1).
Conclusion: One should be aware that patients with tarsal coalition do not always present with a flatfoot and hindfoot valgus,
since many can have a variety of hindfoot and midfoot alignment features. In cases presenting with history of trauma, degenerative
arthritis, as well as a cavovarus or clubfoot deformity, tarsal coalition can easily be clinically overlooked.
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NewsBot · Jan 12, 2023

Review of the role of bone-SPECT/CT in tarsal coalitions
Wouter van der Bruggen et al
Nucl Med Commun. 2023 Feb 1;44(2):115-130

Tarsal coalition (TC) is a congenital abnormal connection (fibrous, cartilaginous, or osseous) between two or more bones in the hind and midfoot, mostly consisting of calcaneonavicular or talocalcaneal coalition, and is often asymptomatic. However, TCs may result in foot motion limitation and pain with or without flatfoot (pes planus), arising in adolescents and young adults. Appropriate imaging is needed to pinpoint foot pain in the (suspected) TC, starting with plain radiographs. Still, normal radiographs do not exclude TCs. Computed tomography (CT) and MRI are frequently used advanced imaging techniques. CT alone has known limited sensitivity in cartilaginous and fibrous TCs and correlation between CT abnormalities and pain may be challenging, as solely anatomical changes in TCs are often asymptomatic. MRI can depict soft tissue abnormalities in TC with high accuracy. Nonetheless, after the implantation of metallic osteosynthesis material, MRI is often limited due to image distortion, signal loss, and misregistration. Bone scintigraphy with [99mTc]Tc-diphosphonate single photon emission computed tomography/CT (bone-SPECT/CT) is a known sensitive tool to detect osteoblastic bone pathology. However, the literature concerning bone-SPECT/CT in TC patients is limited. This article reviews bone-SPECT/CT patterns in TCs, how it complements other imaging techniques and their relation to clinical complaints. Bone-SPECT/CT excels in accurate bone pathology characterization in TC, confidently excluding synchronous lesions elsewhere, and offering optimal insight into osseous structures and 3D-localization of bone metabolism for surgery planning. Furthermore, even with implanted osteosynthesis material, bone-SPECT/CT can pinpoint the culprit pain generator, where MRI is either contra-indicated or considerably hampered.
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NewsBot · Nov 19, 2023

Tarsal coalition in adults
Nazim Mehdi et al
Orthop Traumatol Surg Res. 2023 Nov 16

Adult tarsal coalition consists in abnormal union of two or more tarsal bones. Reported incidence ranges between 1% and 13%. It is generally a congenital condition, due to dominant autosomal chromosome disorder, but with some acquired forms following trauma or inflammatory pathology. Poorly specific clinical signs and the difficulty of screening on conventional X-ray may lead to diagnostic failure.The present review of tarsal coalition addresses the following questions: How to define tarsal coalition? How to diagnose it? How to treat it? And what results can be expected? There are 3 types of tarsal coalition, according to the type of tissue between the united bones: bony in pure synostosis, cartilaginous in synchondrosis, and fibrous in les syndesmosis. Location varies; the most frequent forms are talocalcaneal (TC) and calcaneonavicular (CN), accounting for more than 90% of cases. Cuneonavicular, intercuneal and cuboideonavicular locations are much rarer, at less than 10%.Tarsal coalition is classically painful, often with valgus spastic flat-foot in young adults. The pain is caused by the biomechanical disturbance induced by the bone, cartilage or fibrous bridges which partially or completely hinder hindfoot and/or midfoot motion. Conventional imaging, with weight-bearing X-ray and CT, is standard practice. Weight-bearing CT is increasingly the gold-standard, displaying abnormalities in 3 dimensions. Functional imaging on MRI and tomoscintigraphy assess direct and indirect joint impact at the affected and neighboring joint lines.Non-operative treatment can be proposed, with orthoses, rehabilitation and/or injections. But surgery is the most frequent option: either resection of the bony, cartilaginous or fibrous constructs to restore optimally normal anatomy, or arthrodesis in the affected joint line or the entire joint. Surgery can be open, arthroscopic or percutaneous, depending on the severity of the biomechanical impact on the affected and neighboring joints.Resecting the abnormality is the standard practice in all locations if it affects less than 50% of the talocalcaneal joint line and there is no osteoarthritis to impair the functional outcome. Otherwise, fusion is required.
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NewsBot · Jan 11, 2024

Tarsal coalition in adults
Nazim Mehdi et al
Orthopaedics & Traumatology: Surgery & Research; 17 November 2023, 103761

Adult tarsal coalition consists in abnormal union of two or more tarsal bones. Reported incidence ranges between 1 and 13%. It is generally a congenital condition, due to dominant autosomal chromosome disorder, but with some acquired forms following trauma or inflammatory pathology. Poorly specific clinical signs and the difficulty of screening on conventional X-ray may lead to diagnostic failure. The present review of tarsal coalition addresses the following questions: how to define tarsal coalition? How to diagnose it? How to treat it? And what results can be expected? There are 3 types of tarsal coalition, according to the type of tissue between the united bones: bony in pure synostosis, cartilaginous in synchondrosis, and fibrous in syndesmosis. Location varies; the most frequent forms are talocalcaneal (TC) and calcaneonavicular (CN), accounting for more than 90% of cases. Cuneonavicular, intercuneal and cuboideonavicular locations are much rarer, at less than 10%. Tarsal coalition is classically painful, often with valgus spastic flatfoot in young adults. The pain is caused by the biomechanical disturbance induced by the bone, cartilage or fibrous bridges which partially or completely hinder hindfoot and/or midfoot motion. Conventional imaging, with weight-bearing X-ray and CT, is standard practice. Weight-bearing CT is increasingly the gold standard, displaying abnormalities in 3 dimensions. Functional imaging on MRI and tomoscintigraphy assess direct and indirect joint impact at the affected and neighboring joint lines. Non-operative treatment can be proposed, with orthoses, rehabilitation and/or injections. But surgery is the most frequent option: either resection of the bony, cartilaginous or fibrous constructs to restore optimally normal anatomy, or arthrodesis in the affected joint line or the entire joint. Surgery can be open, arthroscopic or percutaneous, depending on the severity of the biomechanical impact on the affected and neighboring joints. Resecting the abnormality is the standard practice in all locations if it affects less than 50% of the talocalcaneal joint line and there is no osteoarthritis to impair the functional outcome. Otherwise, fusion is required.
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NewsBot · Apr 25, 2024 at 4:50 AM

Tarsal Coalition: Surgical Management in the Young Athlete
Javier Masquijo et al
Source

Tarsal coalition is an abnormal bony, cartilaginous, or fibrous bridge between 2 or more tarsal bones. Adolescent athletes with tarsal coalitions typically present with symptoms that include foot and/or ankle pain and limited range of motion. Loss of mobility can lead to abnormal loading, articular instability, deformity, and joint degeneration. Nonoperative management includes immobilization, physical therapy, and custom foot orthosis. Surgical options include coalition excision and fat graft interposition, foot realignment, or a combination of these. Surgical treatment requires evaluation of the coalition type, foot alignment, and degenerative changes in the adjacent joints.
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