The tarsal bones - the calcaneus, talus, navicular and cuboid-together form joints that are extremely important to proper foot function. When there is abnormal growth of bone cartilage or fibrous tissue across these joints, range of motion either decreases or abates entirely, causing pain in the area.

The most common coalitions occur either across a joint between the talus and calcaneus (talocalcaneal coalition) or between the calcaneus and navicular, (calcaneonavicular coalition) also referred to as a CN bar. These coalitions occur at equal frequency and, more than 50 percent of the time, they occur in both feet and sometimes both coalitions are present.

• pain, typically on the outside and top of the foot (although some children have no pain)
• flat feet or a flat foot (although not all children with flat feet have a tarsal coalition)
• rigidity in the affected foot
• muscle spasms

The symptoms of tarsal coalition may resemble other medical conditions of the foot. Always consult your child's physician for a diagnosis.

• magnetic resonance imaging (MRI) - a diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body.
• computerized tomography scan (Also called a CT or CAT scan.) - a diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce cross-sectional images (often called "slices"), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general x-rays.

• your child's age, overall health, and medical history
• the extent of the condition
• your child's tolerance for specific medications, procedures, or therapies
• expectations for the course of the condition
• your opinion or preference

There are a variety of non-surgical and surgical methods used to treat a tarsal coalition. The primary goal of conservative, non-surgical treatment is to reduce pain and muscle spasm by further reducing range of motion in the affected joint or joints. This is achieved by the use of orthotics, which are special, custom-made shoe inserts that support affected joints. An injection of an anesthetic and a steroid, such as cortisone, may also be given to provide temporarily relief of pain. The doctor may also prescribe anti-inflammatory medication.

Pain may persist despite conservative measures. In that case, your child's doctor will probably recommend surgery. The type of surgery depends on the type and location of the coalition and whether arthritis is involved, and, if it is, how extensive arthritis is. If there are no arthritic changes, the union between the bones is usually resected, so that normal range of motion can occur. However, in some cases, surgery is aimed at limiting the range of motion in the joint that causes pain. In this case, the surgery involves fusing affected joints.

After surgery, as part of the recovery process, a splint or cast, along with crutches are used to immobilize the foot and keep the foot from bearing weight. Exercises to restore muscle tone and range of motion are encouraged, along with walking as soon as possible after adequate healing.