Augustine A. Bollo

Tarsal coalitions in children are not common. However, it is often misdiagnosed as growing pains or shin splints. A tarsal coalition is an abnormal union of two bones in the foot. This condition may involve one or both feet. Symptoms usually occur between the ages of nine and twelve when a child is becoming more active in sports and/or extracurricular related activities. Further, coalitions are congenital and are not caused by an injury, although symptoms may first appear after an acute injury or overuse to the lower extremity.

1. Often vague pain in the foot and/or ankle.
2. Pain in the foot and/or ankle, worse with increase in activity and better with rest.
3. Muscle cramps and/or spasms in the leg.
4. Stiffness in the foot creating difficulty wearing dress shoes.
5. Fatigue or tiredness in the legs, especially with increase in weight bearing activities.
6. Muscle weakness in the legs.
7. Pain in the knees, hips and/or back.

1. Flatfoot with weight bearing.
2. Decreased motion in the midfoot and rear foot joints.
3. Pain with palpation over the midfoot.
4. Pain with attempted range of motion of midfoot and rear foot joints.
5. Often mild local swelling with acute pain.
6. Tenderness in the legs.
7. Difficulty walking.
8. If one foot affected, one foot may appear to turn outward compared to the other foot.
9. Spasms may be produced with muscle examination.
10. Swelling in the midfoot or ankle may be present.

Radiograph findings depends on the type of tarsal coalition present. However, any type of coalition will reveal abnormal bridging of two bones in the mid or rear foot area. Undetected cases will reveal secondary findings such as bone spur formation and/or degenerative changes of certain joints.

Acute symptoms and signs of pain and swelling are treated with cast immobilization and rest. Physical therapy may be implemented to decrease muscle spasms and increase muscle strength. Functional orthotic devices are often utilized to prevent abnormal motion causing pain and stabilization of the foot. When a child has continued pain and difficulty walking and/or has significant joint stiffness, surgical intervention may be required by removing the abnormal bone bridging in which prognosis is excellent.