Most young children have flat feet, at least the flexible kind in which arches flatten when standing but re-emerge when not bearing weight. This is normal—there are usually no symptoms and most kids grow out of it eventually.
However, some forms of pediatric flat feet, such as tarsal coalition are more serious. In this condition, tarsal bones in the hindfoot—usually some combination of the talus, navicular, and heel bone—become connected or fused, often causing stiffness, pain, and rigid flat feet as the child grows.
Identifying Tarsal Coalition and Its Symptoms
Although tarsal coalition is usually already present at birth, in many cases it isn’t identified until early adolescences or even adulthood. Children’s skeletons are still soft and flexible; the pain and stiffness of a tarsal coalition may not arrive until the bones mature, harden, and eventually grow into one another, connected by bone or tough cartilage.
Relatively minor cases may never cause significant noticeable symptoms, remaining undiscovered indefinitely. For those less fortunate, however, symptoms often appear around age 8 to age 16 and may include:
- Stiffness and pain, particularly in the ankle and back half of the foot
- A rigid flat foot
- Feet and legs that tired quickly during activity
- Muscle spasms
Tarsal coalition affects either one or both feet with roughly equal frequency. In most cases a physical examination and digital X-rays will be required to confirm a diagnosis.
Treating Tarsal Coalition Conservatively
We know what you’re thinking, and the good news is no, not all cases require surgery. In fact, most cases can be adequately managed via conservative therapies, and no treatment is necessary if there are no symptoms.
A typical conservative approach to tarsal coalition may include:
- Shoe inserts or orthotics. The right insert will be determined on a case-by-case basis, but may include arch supports, heel cups, wedges, or other pieces. Custom orthotics are created using a mold or scan of the affected foot and crafted specifically to distribute weight away from the affected area.
- Physical therapy. Massage, ultrasound therapy, and exercises to improve flexibility and range of motion may be recommended.
- Immobilization. A temporary boot or cast protects the foot long enough for pain and swelling to subside.
- Rest, ice, OTC pain relievers, and/or steroid injections may also be considered to provide temporary pain relief.
Tarsal Coalition Surgery
If conservative treatments do not provide adequate relief, then we may consider surgery. The decision about whether or not to pursue surgery, as well as which procedure (or procedures) to select, will depend on things like the size and location of the coalition, the age and health status of the patient, and other factors.
The two most common procedures are:
- Resection. Here, the connecting tissue holding bones together is removed and replaced with softer tissues transplanted from elsewhere. This is the most common and preferred type of surgery, as it does the best job at preserving a natural foot motion.
- Fusion. In severe cases with more extensive pain or deformity, permanently fusing the bones to prevent painful joint movement may be required. This will of course lock certain joints into place and restrict certain motions; however, most people can still learn to participate in normal physical activities successfully, without pain.