Tarsal Coalition – When Your Foot Bones Don't Separate Properly

Tarsal Coalition – When Your Foot Bones Don't Separate Properly Your feet contain 26 bones, and normally, they move independently to help you walk, run, and navigate uneven terrain with ease. But when two or more of these bones are abnormally joined together—a condition called tarsal coalition—your foot's flexibility and range of motion become restricted. If you're experiencing unexplained foot pain or stiffness in the Orlando area, understanding tarsal coalition could be the key to finding relief. What Is Tarsal Coalition? Tarsal coalition is a congenital condition where two bones in your foot fail to separate properly during fetal development. Instead of remaining as distinct bones, they become fused or connected by fibrous tissue, cartilage, or bone. The most common sites for this fusion are the calcaneus (heel bone) and the talus (ankle bone), though it can occur in other locations within the foot. This condition affects roughly 1 in 100 to 1 in 3,500 people, though many remain unaware they have it until symptoms develop. If your parents had tarsal coalition, your risk increases significantly, since the condition often runs in families. Causes and Risk Factors Tarsal coalition is primarily genetic —it develops during fetal development when bones that should separate fail to do so. There's no clear understanding of why this happens, but if you have a family history of foot problems, misalignment, or arthritis, your risk is higher. Unlike acquired foot conditions, tarsal coalition isn't caused by injury, lifestyle choices, or activity level. Instead, it's present from birth but typically remains silent until adolescence or early adulthood, when the fusion hardens and symptoms become noticeable. Symptoms You Shouldn't Ignore If you have tarsal coalition, you might experience: Foot pain and stiffness , particularly on the inner side of the foot or ankle Limited ankle motion —difficulty rotating your foot inward or outward Pain that worsens with activity , especially walking on uneven surfaces Flat or rigid feet —your arch may appear flattened or lack normal flexibility Muscle spasms in the feet and lower legs, which develop as your body tries to compensate for the restricted movement Pain that comes and goes , sometimes triggered by stress or increased activity Symptoms often emerge between ages 12 and 25, coinciding with growth plate closure and increased physical demands. However, some people don't develop symptoms until later in life. How Podiatrists Diagnose Tarsal Coalition When you visit our Downtown Orlando, Altamonte Springs, Longwood, Lake Mary, or Sanford locations, your podiatrist will begin with a thorough physical examination. We assess your foot's range of motion, flexibility, and pain patterns. Imaging is essential for diagnosis: X rays reveal bone to bone fusions clearly CT scans provide detailed views of the coalition and help determine its exact location and extent MRI shows soft tissue involvement and helps identify fibrous or cartilaginous coalitions that might not appear on X rays During your visit, we'll also check for signs of compensation—how your body adjusts to the limited motion—as this guides our treatment strategy. Treatment Options: Conservative First, Surgery Only When Needed Your treatment plan depends on the severity of your symptoms and how much the coalition limits your daily activities. Conservative Management For mild to moderate symptoms, we typically start with non surgical approaches: Rest and activity modification —limiting high impact activities like running or jumping Anti inflammatory medications —over the counter NSAIDs to manage pain and swelling Custom orthotics —shoe inserts that provide arch support and reduce stress on the coalition Immobilization —a boot or walking cast to allow inflamed tissues to heal Physical therapy —exercises to strengthen foot and ankle muscles and improve stability Corticosteroid injections —targeted relief for inflammation in specific areas Many people respond well to these conservative measures and regain comfortable function. Surgical Intervention Surgery becomes an option if conservative treatment fails to relieve pain after 3–6 months, or if symptoms significantly limit your daily activities. Surgical options include: Coalition resection —removing or separating the fused bone tissue to restore some movement Subtalar fusion —deliberately fusing the affected joints if arthritis is present, to eliminate pain from abnormal motion Surgical decisions are highly individualized. Dr. Sean Griffin and our surgical team evaluate whether restoration of motion or controlled fusion offers you the best outcome. When to See a Podiatrist Schedule an appointment if you're experiencing persistent foot or ankle pain, especially if it began in your teens or early twenties, or if you notice your feet are unusually stiff and flat. Early diagnosis prevents compensation injuries in other parts of your foot or leg. At Central Florida Foot & Ankle Institu