The Orthobullets Podcast Foundations | Pediatrics | Tarsal Coalition
Jan 8, 2026
Dive into the complexities of tarsal coalition, from its definitions to its epidemiology. Explore clinical presentations, including recurrent sprains and flatfoot. Discover key physical exam findings like hindfoot valgus and limited motion. Uncover imaging techniques and the significance of signs like the anteater. Learn about nonoperative management approaches, including shoe inserts and immobilization, alongside surgical options and considerations. Get insights from a clinical vignette on diagnosis and the rationale for conservative care.
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Congenital Cause And Typical Presentation
- Tarsal coalition arises from failed embryonic segmentation producing abnormal fusion of tarsal bones.
- Most patients remain asymptomatic but can present with flatfoot or recurrent ankle sprains.
Symptoms Correlate With Ossification
- Symptoms often emerge when the coalition ossifies, typically in childhood or adolescence.
- Presenting signs include limited subtalar motion, hindfoot valgus, and an arch that doesn't reconstitute on toe-stand.
Imaging Strategy For Suspected Coalition
- Obtain AP, standing lateral, and a 45° internal oblique when suspecting coalition; include a Harris axial view for heel evaluation.
- Use MRI if radiographs are normal but clinical suspicion for fibrous or cartilaginous coalition remains.