What's causing my childs foot pain?

What is a tarsal coalition and how do I know if my kid has one?


Tarsal coalitions are abnormal connections between the bones in rearfoot or midfoot that are congenital. These abnormal connections limit motion cause flat feet that are rigid and a lot of times painful. The connections can be fibrous, meaning the connections between the bones are due to fibrous tissue, they can be cartilaginous due to excessive cartilage, or bony, meaning the two bones are abnormally fused. The two most common coalitions are the calcaneonavicular (fusion between the heel bone or calcaneus and a midfoot bone called the navicular) and talocalcaneal (connection between the calcaneus and the talus). 50% of coalitions are bilateral and are autosomal dominant, meaning a lot of times they are inherited. 


Calcaneonavicular Coalition:

This typically occur in children 8-12 and are often noted after an ankle sprain. Kids report ongoing pain along the outside of the foot. Rearfoot motion is typically limited especially with bony coalitions. Flat feet are a common sign with a tight Achilles tendon. 

Talocalcaneal coalition:

These typically occur in ages 12-16. Patients typically present for treatment following a minor sprain or trauma. Hindfoot range of motion is usually more limited than what is seen in calcaneonavicular coalitions. Rarely does the foot have a high arched appearance and a severe flat foot is noted. 


Treatment involves xrays and CT scans to evaluate the coalition and to verify if it is fibrous, cartilaginous, or bony. Conservative treatment is tried first. This consists of arch supports and Achilles stretches. A custom orthotic is best and the rearfoot really needs to be controlled to prevent ongoing pain and problems. Some may need a brace or boot depending on the pain level and injury that lead to the discorvery of the coalition. When conservative measures fail, surgery is the next step. Surgery involves removing the abnormal connection and sometimes placing a soft tissue spacer between the bones to prevent them from growing back together. In more extreme cases as with talocalcaneal coalition a fusion of the subtalar joint may be necessary to prevent chronic pain and deformity. 

If your child has a pain in his arch and complains of ongoing pain especially after an injury. It is very important that they be evaluated for any injury or even a possible tarsal coalition. If your child has any of these symptoms, call Dr. Haynes at Elite Foot & Ankle Associates, (503) 668-5210. 

Trevor Haynes, DPM

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