Tarsal Coaliton - diagnosis
I met with a mom and her daughter yesterday to discuss chronic flat foot issues. The patient was an 18 y/o female who described a progressive increase in pain over the past several years. She was now limited from activities that she loved including running and skiing. The mom was concerned about the progression of symptoms and was interested in using orthotics to help her daughter’s pain.
Examination of the feet showed a rigid flatfoot both while sitting and with weight bearing. Range of motion of the foot was very limited and stiff. Ankle range of motion was also limited by a tight calf and Achilles tendon. X-rays were inconclusive for findings. Based on the onset, location of pain and x-rays, all findings seemed to suggest the presence of a fibrous tarsal coalition.
Tarsal Coalition - treatment options
A tarsal coalition is a progressive limitation of bone in the rear portion of the foot. Symptoms of a tarsal coalition increase with age as the coalition (a bridge of bone) changes from soft, flexible tissue to rigid bone. Be sure to read our knowledge base article on tarsal coalitions for more information on this condition.
Tarsal Coalition - stretching and orthotics
How could I answer the question about prescription orthotics or arch supports? In a tarsal coalition, the tight calf muscle is actively acting to flatten the arch. Putting an arch support under the arch of a tarsal coalition can in some cases actually increase the symptoms of pain and stiffness of the foot. In the early stages of tarsal coalition, the foot may accommodate the arch support, but as it grows to be more rigid, an arch support can cause increase pain.
We also discussed physical therapy and stretches as a method of treatment. Just as I mentioned earlier with the use of the inserts, stretches may only help in early stages of tarsal coalition. As the coalition ossifies, the use of both orthotics and stretches become less and less useful.
In this particular case, we are waiting for an MRI to identify the coalition. Once we have that information, a definitive treatment plan can then be mapped.