➢ Calcaneonavicular and talocalcaneal coalitions account for 90% of all tarsal coalitions in the pediatric population.
➢ Computed tomographic (CT) or magnetic resonance imaging (MRI) scans identify tarsal coalitions that are unrecognized on radiographs and provide more information regarding the size, content, and location of coalitions. They are a mandatory component of the evaluation.
➢ Nonoperative measures represent the first line of treatment and may consist of activity modification coupled with nonsteroidal anti-inflammatory medications, the use of shoe inserts or orthotics to elevate the medial arch and to preserve hindfoot alignment, and immobilization in a below-the-knee walking cast to reduce joint stresses and to permit microfractures to heal.
➢ Operative treatment should be considered after nonoperative measures have been exhausted. The selection of the operative procedure should depend on the location of the pain, whether or not the tarsal coalition can be resected, the presence of marked hindfoot alignment, and the presence of arthritis in the Chopart joint.
➢ Patients with talocalcaneal coalitions that are >50% of the size of the posterior talocalcaneal facet and have excessive hindfoot deformity should be counseled, before undergoing coalition resection, about the higher chance of having a poor outcome and requiring a secondary procedure.
A tarsal coalition is a congenital foot anomaly that consists of a fibrous, cartilaginous, or osseous connection between tarsal bones. Originally described in 1764 by de Buffon et al.1 and a century later by Zuckerkandl2 and Holl3, tarsal coalitions have an estimated prevalence of 1% to 2% in the general population4,5 and the majority either are asymptomatic or cause only minor symptoms6. Tarsal coalitions have received considerable attention in the medical literature because of their association with peroneal spastic flatfoot7 as well as with a number of congenital conditions that …