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Tarsal Coalition
A tarsal coalition is a bone condition that
causes decreased motion or absence of motion in one or more of the
joints in the foot. The lack of motion or absence of motion is due to
abnormal bone, cartilage or fibrous tissue growth across a joint. When
excess bone has grown across a joint there is usually little or no
motion in that joint. Cartilage or fibrous tissue growth can restrict
motion of the affected joint to varying degrees causing pain in the
affected joint or in surrounding joints. The
decreased motion can cause pain in surrounding joints as they try to
compensate for the affected joint. When one joint has restricted motion
the surrounding joints will be stressed more than normal. This is an
attempt to "take up the slack" for the diseased joint. Tarsal
coalitions can occur outside of a joint as well. This is referred to as
a bar. A bar connects two bones that don't normally touch or have a
joint between them. The bar will limit motion in surrounding joints
causing abnormal wear and tear to the joints of the foot. This can lead
to early arthritis and pain. The bar itself can be painful as well if
it is incomplete, traumatized during walking, sporting activities, or
an accident. In the foot, the bones found at
the top of the arch, the heel, and the ankle are referred to as the
tarsal bones. Thus, a tarsal coalition is an abnormal connection
between two of the tarsal bones in the back of the foot or the arch.
This abnormal connection between two bones is most commonly an
inherited trait and passed down from generation to generation. All
coalitions are not inherited though. They can also arise from outside
sources such as arthritis, infections, trauma and abnormal bone growth.
These outside causes are much less frequent. Symptoms Patients
with a painful tarsal coalition commonly describe an aching sensation
deep in the foot near the ankle or arch. In many cases, muscle spasm on
the outside of the affected leg is present. This is a natural reaction
of the body as it tries to limit the painful motion occurring in the
foot. Patients may notice that the affected foot is not as flexible and
appears significantly more flattened when compared to the other foot.
This only holds true if only one foot is affected, as it is common for
both feet to be affected. All flat-footed people do not have tarsal
coalitions. There are many causes of flat feet. Symptoms
most commonly appear in the teenage or early adult years depending on
the location of the coalition. It should be noted that not all tarsal
coalitions become symptomatic. The onset of symptoms may be delayed
into adulthood. Diagnosis Diagnosis
of a tarsal coalition can usually be made from symptoms described by
the patient to the doctor. X-rays are usually taken and in most cases a
CT scan or MRI
will confirm the diagnosis and provide valuable information regarding
the type of coalition, its location, and how the joints have been
affected. Treatment There
are a variety of methods to treat a tarsal coalition depending on the
severity of the condition, the age of the patient, and which joint is
affected. Conservative treatment involves non-surgical treatment
options. Conservative treatment is directed toward reducing motion in
the affected joints to decrease pain and muscle spasm. Orthotics
(shoe inserts) are commonly used accomplish this decrease in motion.
Physical therapy and anti-inflammatory medication may be utilized as
well. Cortisone injections in the affected area may provide
relief for an indefinite period of time. These conservative methods of
treatment may or may not provide long-term relief. If
symptoms do persist surgical correction is often entertained. Surgical
intervention will vary depending on the type of coalition, its
location, and the amount of arthritis it has caused in the foot.
Surgery can involve removing the coalition to allow for more normal
motion between the bones. Many times surgery may involve fusing the
affected joint or surrounding joints. This is designed to limit or
completely stop the painful motion of the affected joints. Recovery
from surgery often involves a period of non-weight bearing on crutches
and utilization of a cast. Physical therapy will often be used once the
normal bone healing is complete to restore muscle tone and full
available range of motion.(For more information see Hindfoot and Ankle surgery.
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