Foot

Tarsal Coalition: Painful Rigid Flatfoot in Adolescents

Name: Tarsal Coalition Milan: Diagnosis and Treatment in Children
Creator: Dott. Daniele Priano
Published: 2026-04-18

Foot pain and hindfoot rigidity in a sporty adolescent? Tarsal coalition may be the cause. Learn about diagnosis and treatment options. Pediatric specialist Milan.

Medically reviewed: April 2026·Dott. Daniele Priano

Quick Answers

Is tarsal coalition congenital?

Yes, it is a congenital malformation but it becomes symptomatic only during adolescence, when the fusion ossifies and the foot loses elasticity. Many adolescents discover it only after age 10-12.

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?

Surgery (coalition resection) is considered when pain persists despite 4-6 months of well-conducted conservative treatment, or when the coalition markedly limits the adolescent's quality of life.

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.

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

Rest from sports and temporary immobilization in acute phases
Targeted physical therapy for peroneal relaxation and mobility recovery
Custom orthotics to reduce overload
Surgical treatment (coalition resection or, in selected cases, arthrodesis) when conservative treatment fails

Frequently Asked Questions

Is tarsal coalition congenital?▼

Yes, it is a congenital malformation but it becomes symptomatic only during adolescence, when the fusion ossifies and the foot loses elasticity. Many adolescents discover it only after age 10-12.

Can my child play sports with a tarsal coalition?▼

When is surgery needed?▼

Surgery (coalition resection) is considered when pain persists despite 4-6 months of well-conducted conservative treatment, or when the coalition markedly limits the adolescent's quality of life.

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.