Tarsal Coalitions


 

What is a tarsal coalition?

  • A tarsal coalition is a problem of the rear foot (just below the ankle joint) where the normal motion is not present or reduced.
  • This happens because the bones of the back part of the foot, are abnormally fused together. Patients are typically born with the condition and exhibit symptoms when the bones start maturing in the teenage years.
  • Coalitions are classified based on the type of tissue that binds the bones together (fibrous/scar tissue, or osseous/bone), and the bones that are involved (talocalcaneal, calcaneonavicular, talonavicular).

What are the causes of tarsal coalitions?

  • Genetics is the most likely cause for tarsal coalitions. While they can be present at birth, they don’t manifest until the bones mature and solidify. 
  • Traumatic injuries can sometimes also cause coalitions or bone fusions. 

What Are The Symptoms Of a Tarsal Coalition?

  • Pain is the most common factor that brings a patient to seek help.  The pain can be localized to the rear foot or may be more widespread throughout the entire foot. 
  • Flat feet are secondary effects of coalitions. Muscle spasms(most commonly peroneal tendon spasms) are also commonly associated with tarsal coalitions. 
  • Undiagnosed coalitions can lead to arthritis and severe pain. 

How Are Coalitions Diagnosed?

  • A clinical exam and assessment of the rang of motion may reveal a possible underlying coalition. Unfortunately, coalitions go undiagnosed for a long period of time in many patients, due to the to lack of symptoms.
  • If flat feet are present, this often alerts the doctor to investigate deeper.
  • Some coalitions are easily visible on x-ray, and others are seemingly invisible. Other diagnostic modalities like an MRI and/or a CT scan will reveal the coalition. 

What are the treatments for tarsal coalitions?

Conservative/ Non-operative treatment

  • Wear proper supportive shoes
  • Use a foot orthotics
  • Modify your activities
  • Decrease physical activities
  • Anti inflammatory medications
  • Cortico steroid injections

Surgical Options 

  • Removal of the tarsal coalition
  • Removal of the tarsal coalition combined with a flat foot reconstruction surgery
  • Fusion of the affected bones

 Surgical Options

 

Removal of the Tarsal Coalition

The surgery involves simply removing the abnormal tissue to allow motion across the affected joints. 

After resection of the coalition the remaining bone is either coated with bone wax or a soft tissue spacer, such as fat or muscle, is placed at the site where the coalition used to be, to prevent recurrence. 
 

Removal of the Tarsal Coalition

Through his extensive training, Dr. Majdanski has been able to master minimal incision techniques to resect the coalitions. 

Pictured above is a middle facet coalition which was resected through a 2cm incision. 
 

 

Removal of the coalition along with flat foot reconstruction

The surgery involves resecting the coalition, along with realigning the foot to a more corrected position. 

Realignment of the foot can be achieved through bony work with grafting(as pictured above) as well as placement of an arthroreisis. 

 

Fusion of affected bones

The last option for treating coalitions is fusing the affected joints. 

The decision for this option depends on the amount of damage that has been created by the coalition. 

Dr. Majdanski aims to avoid this procedure for coalitions, unless absolutely necessary. 

The procedure is reserved for severe cases, in which realigning the foot and fusing the bones in a proper position is beneficial to the patient. 

By fusing the bones of the back fo the foot, a possibility of affecting other joints in the foot or ankle may arise. 

What Anesthesia Is Needed For Tarsal Coalition Surgery

Tarsal Coalition surgery is performed  both in an outpatient or inpatient setting, depending on the extent of the work needed. 

More often the surgery is performed under a regional, spinal or general anesthetic. 

For a sole coalition resection,  local anesthesia with sedation can be used. 

What Are The Risks Of Tarsal Coalition Surgery

Just as any other surgery, tarsal coalition surgery has general risks. 

Complications may occur with any surgery and are not necessarily your fault, or the fault of your surgeon. Nonetheless, you should understand the risks.

Tarsal Coalition surgery complications include, but are not limited to: infection, pain (temporary or permanent), swelling, hematoma, bleeding, blood clot, poor wound healing, incision breakdown, poor bone healing (delayed union, nonunion), nerve injury, disability, recurrence, scarring, stiffness, weakness, hardware problems, need for revisional surgery, and/or catastrophic loss.

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