Tarsal Coalition | Arunalaya Healthcare

Best Tarsal Coalition treatment in Delhi

What is Tarsal Coalition ?

A tarsal coalition is an abnormal connection that develops between two or more bones in the back of the foot (the tarsal bones). These bones are crucial for the flexibility and proper movement of the foot, especially the subtalar joint, which allows for inversion (foot turning inward) and eversion (foot turning outward).

The connection can be made of:-

Bone (synostosis): A complete bony fusion.
Cartilage (synchondrosis): A cartilaginous bridge.
Fibrous tissue (syndesmosis): A fibrous band.

This abnormal connection restricts the normal motion between the affected bones, leading to stiffness, pain, and often a rigid flatfoot deformity.

Anatomy of Tarsal Bones:

The tarsal bones include:
- Talus: The uppermost bone, forming the lower part of the ankle joint.
- Calcaneus: The heel bone.
- Navicular: A boat-shaped bone in the midfoot.
- Cuboid: On the outer side of the midfoot.
- Cuneiforms (medial, intermediate, lateral): Small bones in the midfoot.

The two most common sites for tarsal coalitions are:-

Talocalcaneal coalition: Between the talus and the calcaneus.
Calcaneonavicular coalition: Between the calcaneus and the navicular bone.

Causes of Tarsal Coalition:-

Tarsal coalition is primarily a congenital condition, meaning it is present at birth. It occurs due to a failure of the bones to properly separate or segment during fetal development. While it is a developmental abnormality, symptoms often do not appear until later childhood or adolescence when the cartilaginous or fibrous connections begin to ossify (harden into bone).

Less common causes can include:
- Trauma
- Infection
- Arthritis (though typically, this leads to acquired fusion, not congenital coalition)

Tarsal coalition can affect one or both feet, and it is more common in males. There can be a genetic predisposition, with an autosomal dominant inheritance pattern proposed in some cases.

Symptoms of Tarsal Coalition

Many individuals with tarsal coalitions remain asymptomatic throughout their lives. Symptoms typically emerge when the coalition starts to ossify and restrict movement, often between the ages of 8 and 16 years, but sometimes not until adulthood, especially after a minor injury.

When symptoms do occur, they may include:-
- Pain: The most common symptom. It’s usually felt below the ankle, in the middle or back part of the foot, and often worsens with activity.
- Stiffness: Reduced range of motion in the foot and ankle, particularly affecting subtalar joint motion (inversion and eversion).
- Rigid Flatfoot: A characteristic presentation is a “rigid” flatfoot, meaning the arch does not appear when the foot is non-weight-bearing or when the person stands on their toes. This differs from flexible flatfoot.
- Difficulty walking on uneven surfaces: Due to the lack of flexibility in the foot, the ankle may have to compensate, leading to awkward gait.
- Limping: Especially after prolonged activity.
- Muscle spasms: In the leg muscles, particularly the peroneal muscles (on the outside of the lower leg), which may cause the foot to turn outward (peroneal spastic flatfoot). These spasms are often the body’s attempt to immobilize the painful joint.
- Frequent ankle sprains: Because the foot’s normal shock absorption and adaptability are limited, forces that would normally be dissipated through foot movement can instead be transferred to the ankle, leading to recurrent sprains.
- Tired or fatigued legs.

Advanced Physiotherapy for Tarsal Coalition

Physiotherapy plays a significant role in both the non-surgical and post-surgical management of symptomatic tarsal coalition.

Goals of Physiotherapy:-
- Pain reduction.
- Improvement of foot mechanics and alignment.
- Enhancement of functional mobility.
- Prevention of compensatory issues in other joints (e.g., ankle, knee, back).
Manual Therapy:
- Soft Tissue Mobilization: Gentle massage, myofascial release, or instrument-assisted soft tissue mobilization (IASTM) for tight muscles (e.g., peroneal muscles, calf muscles) that may be in spasm or shortened due to the rigid foot. This helps to reduce pain, improve circulation, and prepare tissues for stretching.
- Gentle Joint Mobilizations: While the coalition itself is stiff or fused, adjacent and compensatory joints (e.g., ankle joint, midfoot joints) can become stiff or hypermobile. Manual therapy can be used to maintain or restore optimal mobility in these surrounding joints, provided it does not stress the coalition. For example, talocrural mobilizations (ankle joint) to improve dorsiflexion/plantarflexion or gentle midfoot mobilizations might be appropriate. Direct, forceful manipulation of the coalition or subtalar joint in a rigid foot is generally contraindicated or highly cautious due to the risk of exacerbating pain or causing further injury.
Therapeutic Exercises:
- Calf Stretching: To address tightness in the gastrocnemius and soleus muscles, which can worsen flatfoot and pain.
- Peroneal Stretching: To address tightness in the peroneal muscles (if spastic).
- Foot Intrinsic Muscle Strengthening: Exercises like towel curls, marble pickups, and short foot exercises to improve arch support and local foot stability.
- Gait Re-education: Instruction on proper walking mechanics to minimize compensatory movements and reduce stress on the coalition.
- Balance and Proprioception: After pain subsides, simple balance exercises on stable surfaces, progressing to unstable surfaces (if appropriate), to improve ankle stability and proprioception, especially if there is a history of recurrent ankle sprains.
Modalities:
- Ice/Cold Therapy: To reduce pain and inflammation, especially after activity.
- Heat Therapy: Before exercises or stretching to relax muscles.
- Ultrasound or Electrical Stimulation: For pain relief and tissue healing, although evidence for these modalities in TC is limited.

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