Tarsal coalition is a condition where a bridge of bone or cartilage restricts or prevents motion between two or more tarsal bones. It is caused by incomplete division during development and commonly leads to a rigid flat foot. Tarsal coalitions can be classified by tissue type, anatomical location, or an articular classification system dividing them into juvenile and adult types. Common coalitions involve the talocalcaneal and calcaneonavicular joints. Clinical features include foot pain and stiffness while imaging shows a bony bridge between affected joints. Treatment ranges from non-operative options to surgical procedures like resection, fusion, or triple arthrodesis depending on type and symptoms.

2. Condition in which
there is a bridge of bone
or cartilage which
causes restricted or
absent motion between
two or more tarsal
bones.

3. Mesenchymal origin
Incomplete division leads to
tarsal coalition

4. Rigid flat foot in
children is most often
due to tarsal coalition.

5. ClassificationClassification
Etiological
Acquired Arthritis
Infection
Neoplasia
Trauma
Congenital

6. Tissue typeTissue type
Bone -- synostosis
Cartilage -- synchondrosis
Fibrous tissue-- syndesmosis

7. AnatomicalAnatomical
Talo-calcaneal
Calcaneo-navicular
Post talo-calcaneal
Cubo-navicular
Talo-navicular
Calcaneo-cuboid

8. Articular classification systemArticular classification system
 Juvenile (Osseous
Immaturity)
Type I - Extra-
articular coalition
A - No secondary arthritis
B - Secondary arthritis
Type II - Intra-
articular coalition
A - No secondary arthritis
B - Secondary arthritis
 Adult (Osseous
Maturity)
Type I - Extra-
articular coalition
 A - No secondary
arthritis
 B - Secondary arthritis
Type II - Intra-
articular coalition
 A - No secondary
arthritis
 B - Secondary arthritis

9. Talo-calcaneal coalitionTalo-calcaneal coalition
Harris-Beath (1948)
Ossify between 12-16 yrs
Foot fatigue
Hind foot pain
Loss of longitudinal arch
Peroneal spasm

11. Subtalar motion – reduced or
absent
Sinus tarsi tenderness
Tenderness over talo-navicular
jt
Heel valgus

12. X-RAYX-RAY
Posterosuperior oblique
projection
Joint space replaced by a bony
bridge
C- sign on lateral view of the
ankle& foot

15. TreatmentTreatment
Non-operative– decreased activity
walking cast
arch support

16. Surgical treatmentSurgical treatment
Arthrodesis– talonavicular
talocalcaneal
 triple arthrodesis
 subtalar fusion

17. Calcaneo-navicular coalitionCalcaneo-navicular coalition
Zuckerkandl, Holl & Pfitzner
Relationship to pes planus- Holl
& Slomann
Lateral oblique roentgenogram

18. Clinical featuresClinical features
Ossifies at 8-12 yrs
Incomplete coalitions – more
symptomatic
Vague dorsolateral foot pain
Difficulty to walk on uneven surfaces
Foot fatigue
Painful limp

19. Subtalar motion – reduced
Longitudinal arch flattening
Hindfoot valgus
Peroneal spasm

20. Fracture of the bar or sprain
of the fibrous bar produces
severe pain and peroneal
spasm

21. X-RAYX-RAY
45 o
lateral oblique view
Pseudocoalition – prominence of
anterior tuberosity of calcaneus

23. TreatmentTreatment
Rest, heat, immobilisation in
cast
Arch support
Moulded shoes

24. Surgical optionsSurgical options
Resection of bar
Subtalar arthrodesis
Triple arthrodesis

25. Juvenile - IAJuvenile - IA
Resection with interposition of EDB muscle
Resection with interposition of adipose
tissue
Resection with varus-producing calcaneal
osteotomy
Resection with insertion of implant
Varus-producing osteotomy alone

26. Juvenile - IBJuvenile - IB
Resection with interposition of EDB muscle
Resection with interposition of adipose
tissue
Resection with varus-producing calcaneal
osteotomy
Resection with insertion of implant
Varus-producing osteotomy alone
Triple arthrodesis

27. Juvenile - IIAJuvenile - IIA
Resection alone
Resection with interposition of adipose
tissue
Resection with interposition of arthroereisis
Resection with varus-producing calcaneal
osteotomy
 Varus-producing calcaneal osteotomy
alone
 Isolated/single arthrodesis
Triple arthrodesis

28. Juvenile - IIBJuvenile - IIB
 Triple arthrodesis

29. Adult - IAAdult - IA
Resection with interposition of EDB muscle
Resection with interposition of adipose
tissue
Resection with varus-producing calcaneal
osteotomy
Resection with insertion of implant
Varus-producing osteotomy alone
Triple arthrodesis

30. Adult - IB
 Resection with isolated/single arthrodesis
 Triple arthrodesis
Adult - IIA
 Isolated/single arthrodesis
 Triple arthrodesis
Adult - IIB
 Triple arthrodesis