Foot

    Tarsal Coalition: Painful Rigid Flatfoot in Adolescents

    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.
    See all 3 questions →

    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

    • 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?▼
    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.

    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.

    Scientific references

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