Tarsal Coalition | Treatments

How is tarsal coalition treated?

Boston Children's Hospital's Orthopedic Center specialists provide comprehensive treatment—including evaluation, diagnosis, consultation and follow-up care.

But in the case of tarsal coalition, about 75 percent of children with the condition never even need treatment. And of the 25 percent who do need treatment, up to one-half don't need surgery.

If needed, specific treatment for tarsal coalition will be determined by your child's physician based on:

  • 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

Non-surgical treatments

There are several non-surgical methods used to treat a tarsal coalition. The primary goal of conservative, non-surgical treatment is to reduce pain and muscle spasms by further reducing range of motion (immobilization) in the affected joint or joints. Treatments can include:

  • casts or walking boots
  • orthotics—special, custom-made shoe inserts that support affected joints
  • injection of an anesthetic and a steroid, such as cortisone, for temporary pain relief
  • anti-inflammatory medications
  • stretching and physical therapy

If surgery is needed

If your child's pain persists or recurs despite conservative measures, your child's doctor will probably recommend surgery.

  • The type of surgery depends on the type and location of the coalition, whether arthritis is involved, and, if it is, how extensive the arthritis is.
  • If there are no arthritic changes, the union between the bones is usually removed (resected), with fat or muscle placed where the tarsal coalition was so that normal range of motion can occur.
  • In more severe cases, surgery is aimed at limiting the range of motion in the joint that causes pain. In this instance, the surgery involves fusing affected joints and reduce pain.

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 early at one to two weeks after surgery. Walking and full strengthening begins about one month after surgery.

Care after surgery

After surgery, your child will probably stay in the hospital overnight, and be given pain medication. They''ll wear a cast when she goes home; the''ll need to limit her weight-bearing activities for about a month; and they may use crutches or a walker for a few weeks. At this point, therapy is aimed mostly at regaining range of motion and preventing the bone bridge (coalition) from re-forming.

After about a month they'll go into a walking boot and begin strengthening exercises. Physical therapy will help their restore her muscle strength. They'll probably be able to resume full activities, including sports, after three to six months. However, a full recovery can take up to a year.

Coping and support

At Boston Children's Hospital, we understand that a hospital visit can be difficult. So, we offer many amenities to make your child's—and your own—hospital experience as pleasant as possible. Visit the Center for Families for all you need to know about:

  • getting to Boston Children's Hospital
  • accommodations
  • navigating the hospital experience
  • resources that are available for your family

In particular, we understand that you may have a lot of questions when your child is diagnosed with tarsal coalition. Will my child need surgery? When will her foot be normal? Will it affect her long term? Boston Children's Hospital can help you connect with extensive resources to help you and your family through this stressful time, including:

  • patient education: From doctor's appointments to treatment to follow-up, our nurses and physical therapists will be on hand to walk you through your child's diagnosis, treatment (if any) and recovery. And once your child is home, we'll help you coordinate and continue the care and support she received at Children's.
  • parent-to-parent: Want to talk with someone whose child has been treated for tarsal coalition? Our Orthopedic Center can often put you in touch with other families who've been through the same experience that you and your child are facing.
  • faith-based support: If you're in need of spiritual support, we'll connect you with the Boston Children's chaplaincy. Our program includes nearly a dozen clergy—representing Protestant, Jewish, Muslim, Catholic and other faith traditions—who will listen to you, pray with you and help you observe your own faith practices during your hospital experience.
  • social work: Our social workers and mental health clinicians have helped many other families in your situation. We can offer counseling and assistance with issues such as coping with your child's diagnosis, stresses relating to coping with illness and dealing with financial issues.

The Experience Journal

Designed by Boston Children's psychiatrist-in-chief David DeMaso, MD, and members of his team, the Experience Journal is an online collection of thoughts, reflections and advice from kids, parents and other caregivers about a variety of medical experiences, including hip problems.