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

By Dr. Carli Hoover, DPM

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 The AAOS foot-and-ankle arthritis page lists that same morning-or-after-rest stiffness as a hallmark of an irritated joint, which is why a fused or poorly moving midfoot often gets worked up for arthritis as well as coalition.
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 Lake Mary (Waymont and MedPlex) or Downtown Orlando / SODO locations, your podiatrist will begin with a thorough physical examination. People also drive in from Sanford, Altamonte, and Longwood — we do not have offices in those towns. 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. Carli Hoover 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 Institute, we've helped hundreds of patients in the Orlando, Altamonte Springs, Longwood, Lake Mary, and Sanford communities manage tarsal coalition and return to the activities they love.

Call (407) 307-0006 or book your appointment at https://floridafai.intakeq.com/booking today. Let's get your feet back to normal.

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