Foot

Tarsal Coalition: Painful Rigid Flatfoot in Adolescents

Foot pain and hindfoot rigidity in a sporty adolescent can point to a tarsal coalition: how it is diagnosed and treated.

Updated: September 2026·Medically reviewed by Dr. Daniele Priano

Quick Answers

Is tarsal coalition congenital?
Yes, it is a congenital connection between tarsal bones, made of fibrous tissue, cartilage or bone. It may remain asymptomatic. Pain and stiffness often develop during growth, but not only in adolescence or only when the connection ossifies.
Can my child play sports with a tarsal coalition?
It depends on symptoms and the type of coalition. Asymptomatic or well-compensated forms allow sports with adjustments. Painful forms require modulation and sometimes temporary suspension. The plan must be individualized.
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Tarsal coalition is an abnormal fusion — bony, cartilaginous or fibrous — between two tarsal bones. It is one of the most common causes of painful rigid flatfoot in the sporty adolescent.

The most frequent forms are calcaneonavicular (typically symptomatic at 8-12 years) and talocalcaneal (12-16 years). The first symptom is often vague hindfoot pain after a minor trauma or an increase in sports activity.

Diagnosis is based on clinical examination (subtalar rigidity, peroneal spasm) and imaging: X-ray with dedicated views, CT or MRI to define extent and type.

Assessment and treatment

When to seek evaluation

  • Hindfoot or midfoot pain in a sporty adolescent
  • Subtalar rigidity (limited inversion/eversion)
  • Flatfoot that suddenly becomes symptomatic
  • Peroneal muscle spasm or contracture
  • Recurrent ankle sprains without obvious cause
  • Difficulty walking on uneven ground

What is evaluated

  • Subtalar and midtarsal mobility
  • Peroneal spastic test
  • Gait and hindfoot posture examination
  • X-ray with 45° oblique view (for calcaneonavicular coalition)
  • CT or MRI for confirmation and classification (bony, cartilaginous, fibrous)

Treatment options

  • Initial management of loading and pain-provoking activities according to symptoms
  • Immobilisation, supports or physiotherapy may be selected in individual cases; there is no single sequence for every child
  • Surgical decision-making depends on coalition site and extent, alignment, residual motion, symptoms and response to non-operative care
  • Coalition resection or other procedures are discussed only after examination and imaging identify the structure responsible for symptoms

Frequently Asked Questions

Is tarsal coalition congenital?▼
Yes, it is a congenital connection between tarsal bones, made of fibrous tissue, cartilage or bone. It may remain asymptomatic. Pain and stiffness often develop during growth, but not only in adolescence or only when the connection ossifies.
Can my child play sports with a tarsal coalition?▼
It depends on symptoms and the type of coalition. Asymptomatic or well-compensated forms allow sports with adjustments. Painful forms require modulation and sometimes temporary suspension. The plan must be individualized.
When is surgery needed?▼
There is no number of months that automatically creates a surgical indication. First, the coalition must be confirmed as the source of symptoms and an appropriate individual non-operative pathway considered. If pain and functional limitation remain important, the choice between resection and other procedures depends on site, extent, foot alignment, residual motion and any joint changes. Examination and imaging distinguish presentations that may look similar but require different decisions.
Does the difference between a fibrous and a bony coalition determine treatment?▼
The tissue type — fibrous, cartilaginous or bony — and the degree of ossification are only part of the assessment. They do not determine treatment on their own: a fibrous coalition does not automatically mean conservative care, nor a bony coalition surgery. Decisions mainly depend on symptoms and their impact on daily life and sport, the extent and location of the coalition, remaining subtalar movement, overall foot alignment, any joint degeneration and the response to conservative treatment.

Important Notice: The information on this page is for educational and informational purposes only and does not constitute medical advice. Each clinical case is unique: the appropriate treatment is determined during the specialist consultation, based on a thorough clinical examination and, where necessary, diagnostic imaging. For any doubts or concerns, please consult a specialist.