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J Pediatr Orthop 2021 Jul;41(Suppl 1):S39-S46

Campbell Clinic Orthopaedics, Memphis, TN.

Introduction: Hindfoot deformities in the pediatric population can be painful and result in severe limitations. Although arthrodesis is known to relieve pain, there are concerns over its use because of the risk that adjacent joint degenerative disease could result, leading to a new source of pain, dysfunction, and additional surgical procedures later in life.

Methods: A literature review of hindfoot fusions in children focused on articles with the highest levels of evidence and those of particular historical significance. Read More

Skeletal Radiol 2021 May 17. Epub 2021 May 17.

Department of Radiology, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP, Middlesex, UK.

Flatfoot is commonly encountered in the paediatric population and describes a spectrum of clinical and radiological presentations which encompass both normally developing and pathological feet. Flatfoot can be categorised as flexible or rigid, a distinction which has important implications when considering the potential underlying aetiology and treatment options, and therefore imaging is an important component of the diagnostic workup. Weight-bearing plain radiographs are established initial investigations, although the significance of a number of the commonly derived quantitative parameters in children remains unclear. Read More

Foot (Edinb) 2021 Jun 8;47:101797. Epub 2021 Apr 8.

Northwestern Memorial Hospital, Chicago, IL, USA.

Displaced isolated fractures of sustentaculum tali are rare. Inadequate treatment of these injuries can rarely lead to non-union or mal-union and in most cases are treated non-surgically. We report a unique case of undiagnosed mal-union of sustentaculum tali in the setting of underlying tarsal coalition that resulted in symptoms of tarsal tunnel. Read More

JBJS Case Connect 2021 Mar 24;11(1):e20.00360. Epub 2021 Mar 24.

Division of Pediatric Orthopedic Surgery, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York.

Case: An 11-year-old boy demonstrated chronic medial hindfoot pain. A 12-year-old boy experienced acute pain and swelling in his right medial ankle and hindfoot after a fall. This is the first report of sustentaculum tali fractures adjacent to a talocalcaneal tarsal coalition, likely resulting from a stress riser created by a rigid subtalar joint. Read More

J Orthop Case Rep 2020 Jul;10(4):35-37

Department of Foot and Ankle Orthopaedics, Sunshine Global Hospitals, Vadodara, Gujarat, India.

Introduction: Tarsal coalitions in the general population are low, possibly due to the asymptomatic nature. In the symptomatic group, however, the presentation is usually during adolescence or early adulthood. The occurrence of a triple tarsal coalition is extremely rare, especially if not associated with a syndrome. Read More

JBJS Case Connect 2021 Jan 14;11(1):e19.00404. Epub 2021 Jan 14.

Department of Orthopaedics and Sports Medicine, Temple University Hospital, Philadelphia, Pennsylvania.

Case: Tarsal coalitions are relatively common, but there are no reports of cuneiform-to cuneiform coalition in the English language literature. The authors present a case of medial-to-intermediate cuneiform coalition in a young female track athlete. Previous nonoperative treatments had been unsuccessful. Read More

Foot (Edinb) 2021 Mar 13;46:101752. Epub 2021 Jan 13.

Kent State University College of Podiatric Medicine, 6000 Rockside Woods Blvd. Independence, OH 44131, United States. Electronic address:

Objective: The C-sign on lateral radiographs has been subject to considerable debate with respect to its reliable association to subtalar joint tarsal coalition. The purpose of this study was to determine to what degree subtalar joint pronation factors into (a) the appearance of both complete and incomplete type A C-signs and (b) the conspicuity of the middle facet in both flatfeet and rectus feet.

Study Design: Forty-seven normal adult volunteers were enrolled into the study with a total of 92 feet, of which 42 were flexible flatfeet and 50 were rectus feet with normal subtalar joint range of motion. Read More

J Child Orthop 2020 Dec;14(6):537-543

Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA.

Purpose: Tarsal coalitions are congenital fusions of two or more tarsal bones and can lead to foot pain and stiffness. Few studies examine the long-term reoperation rates following paediatric tarsal coalition surgery.

Methods: A population-based database, linking medical records at all medical centres to capture the entire medical history of the full population of a Midwest county, was used to identify tarsal coalitions in children between 1966 and 2018. Read More

J Child Orthop 2020 Oct;14(5):433-439

Departments of Orthopaedics, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.

Purpose: This study was designed to review the diagnostic yield of single photon emission computed tomography-computed tomography (SPECT/CT) in children with complex foot/ankle pain.

Methods: We reviewed the records of 33 patients with complex foot and ankle pain referred for SPECT/CT (36 scans) performed between 1st September 2009 to 30th September 2019. All patients had foot and ankle radiographs and 18 out of 33 patients had undergone magnetic resonance imaging (MRI) prior to SPECT/CT. Read More

J Bone Joint Surg Am 2021 Jan;103(2):155-161

Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota.

Background: Tarsal coalitions are an important reason for foot pain in children. Early estimates placed the prevalence at up to 2%, while more recent data suggest that it is as high as 11% to 13%. To our knowledge, there have been no population-based studies to determine the true incidence of symptomatic tarsal coalitions in a pediatric population. Read More

J Orthop 2020 Sep-Oct;21:537-543. Epub 2020 Sep 22.

Consultant Trauma & Orthopaedic Surgeon, Eastbourne District General Hospital, East Sussex Healthcare NHS Trust, Eastbourne, United Kingdom.

Background: Arthroscopic resection of tarsal coalitions is a relatively new technique. This systematic review aimed to investigate the post-operative complications and functional outcomes in arthroscopic resection of tarsal coalitions.

Methods: PubMed, Medline, Embase and Cochrane library were searched for studies that reported outcomes in arthroscopic resection of tarsal coalitions. Read More

Rev Esp Cir Ortop Traumatol (Engl Ed) 2020 Nov - Dec;64(6):375-379. Epub 2020 Aug 10.

Hospital Universitario y Politécnico La Fe, Valencia, España.

Tarsal coalition has an incidence between 2-5% of the general population, and calcaneonavicular is the most frequent (53%). When conservative treatment fails, surgical resection must be indicated. Endoscopic resection is a less invasive technique and can be considered an alternative with better functional recovery. Read More

JBJS Case Connect 2020 Jul-Sep;10(3):e2000090

1Department of Orthopaedic Surgery, Shriners Hospitals for Children Northern California, Sacramento, California 2Division of Orthopedic Surgery, Rady Children's Hospital, San Diego, California.

Case: Talocalcaneal coalition (TCC) is a common type of coalition, often neglected. This case is of a 10-year-old girl with a painful ankle mass, diagnosed with TCC and a ganglion cyst. Examination revealed stiff subtalar motion, a submalleolar prominence, and well-circumscribed, tender mass at the posteromedial ankle. Read More

Foot Ankle Clin 2020 Sep 4;25(3):493-503. Epub 2020 Jul 4.

Trauma and Orthopaedics Department, Royal Cornwall Hospitals NHS Trust, Royal Cornwall Hospital, Treliske, Truro TR1 3LQ, UK.

Endoscopic resection of tarsal coalitions is technically feasible for both talocalcaneal and calcaneonavicular coalitions. Careful consideration of each individual patient is necessary before proceeding with endoscopic resection. Endoscopic resection of these coalitions may offer benefits in terms of faster recovery and less wound problems, but this has not been proven. Read More

Medicine (Baltimore) 2020 Jun;99(26):e20893

Department of Orthopaedic Surgery, Soonchunhyang University Hospital Cheonan, Dongam-gu, Cheonan.

Rationale: Tarsal tunnel syndrome (TTS) is a compressive neuropathy of the posterior tibial nerve and its branches. Tarsal coalition is defined as a fibrous, cartilaginous, or osseous bridging of 2 or more tarsal bones. TTS with tarsal coalition is uncommon. Read More

Clin Orthop Surg 2020 Jun 14;12(2):245-251. Epub 2020 May 14.

Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea.

Background: Accessory bones and tarsal coalitions are the most common developmental variations of the foot and ankle. However, their clinical implications are not well understood because there is no established prevalence data in the normal population and the reported prevalence varies widely. Therefore, we aimed to investigate the incidence of accessory ossicles and tarsal coalitions in a healthy, asymptomatic Korean population. Read More

Arthrosc Tech 2020 Apr 27;9(4):e559-e563. Epub 2020 Mar 27.

Department of Orthopaedics and Traumatology, North District Hospital, Hong Kong SAR, China.

Posterior ankle pain is a common foot and ankle problem faced by orthopaedic surgeons. It can have many causes, including posterior ankle joint pathologies (synovitis or osteochondral lesion), ankle impingement (posterior, posterolateral, or posteromedial), flexor hallucis longus pathologies, peroneal tendon problems, posterior tibial tendinopathy, Achilles tendon pathology, posterior subtalar tarsal coalition, or tarsal tunnel syndrome. Most of these pathologies can be managed effectively by an endoscopic approach. Read More

JBJS Essent Surg Tech 2020 Jan-Mar;10(1). Epub 2020 Feb 13.

Steps2Walk, Inc., Baltimore, Maryland.

Middle facet tarsal coalition is one of the commonly seen tarsal coalitions in clinical practice that can cause pain and associated flatfoot deformity. Excision of the coalition is one of the treatment options for symptomatic cases. Although symptoms may subside in children following a period of immobilization, resection should be considered as a treatment alternative for children and adolescents because of the potential for restoration of subtalar joint movement. Read More

Skeletal Radiol 2020 Sep 14;49(9):1413-1422. Epub 2020 Apr 14.

Department of Radiology, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK.

Objectives: Extra-articular posteromedial talocalcaneal coalition (EA-PM TCC) accounts for approximately one-third of TCC, but its radiographic features are not well-described. The current study aims to compare the radiographic features of EA-PM TCC with normal ankles and with the commoner forms of TCC.

Materials And Methods: A retrospective review of cases of TCC over 12 years for whom radiographs, CT, and/or MRI study were available. Read More

BMC Musculoskelet Disord 2020 Mar 24;21(1):185. Epub 2020 Mar 24.

Pediatric Orthopedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.

Background: The management of painful rigid flatfoot (RFF) with talocalcaneal coalition (TCC) is controversial. We aimed to compare operative and nonoperative treatment in children with RFF and TCC.

Methods: We retrospectively reviewed medical records and radiographs of children with RFF and TTC treated between 2005 and 2015. Read More

EFORT Open Rev 2020 Feb 26;5(2):80-89. Epub 2020 Feb 26.

Department of Pediatric Orthopaedics, Sanatorio Allende, Córdoba, Argentina.

A tarsal coalition is an abnormal connection between two or more tarsal bones caused by failure of mesenchymal segmentation.The two most common tarsal coalitions are calcaneonavicular coalition (CNC) and talocalcaneal coalition (TCC). Both CNC and TCC can be associated with significant foot and ankle pain and impaired quality of life; there may also be concomitant foot and ankle deformity. Read More

J Foot Ankle Surg 2020 Mar - Apr;59(2):385-387

Assistant Professor, Department of Orthopedic Surgery, Rasoul-e-Akram Hospital, Iran University of Medical Science, Tehran, Iran. Electronic address:

Tarsal coalition is a condition characterized by abnormal connections between ≥2 tarsi. Although tarsal coalition is not rare, tarsal coalitions involving >2 tarsi are very unusual. In this report, we describe a case of multiple tarsal coalitions in a 24-year-old male who experienced progressively worsening pain for 3 to 4 months before presenting for care. Read More

Acta Radiol 2020 Nov 19;61(11):1541-1544. Epub 2020 Feb 19.

SEDI II - Eigier Diagnósticos, São Paulo - SP, Brazil.

Background: Fibrocartilaginous coalition of the third tarsometatarsal joint has been indicated as an extremely rare form of tarsal coalition in the radiological literature, and most articles concerned with tarsal coalition do not mention involvement of this joint. Only two reports written in the English language that approach this subject were found, an orthopedic report and an anthropological report.

Purpose: To evaluate the prevalence of this finding and discuss and illustrate the radiological characteristics of this coalition. Read More

Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2020 Feb;34(2):173-178

Department of Foot and Ankle Surgery, Zhengzhou Orthopaedics Hospital, Zhengzhou Henan, 450052, P.R.China.

Objective: To investigate the effectiveness of the Evans lateral lengthening calcaneal osteotomy (E-LLCOT) in treatment of talocalcaneal coalition (TCC) with hindfoot valgus deformity.

Methods: Between January 2014 and October 2017, 10 patients (13 feet) of TCC with hindfoot valgus deformities underwent E-LLCOTs. There were 6 males (8 feet) and 4 females (5 feet) with an age of 13-18 years (mean, 15. Read More

Instr Course Lect 2020 ;69:371-380

Tarsal coalitions are common, but fortunately the majority of patients with coalitions are asymptomatic and do not require intervention. When symptomatic, preoperative radiographs and CT scans are useful to characterize the type and extent of coalition. If a trial of nonsurgical management fails, resection, deformity correction, and triple arthrodesis may be considered. Read More

Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2020 Jan;34(1):46-52

Department of Orthopedics, the Second Affiliated Hospital of Fujian Medical University, Quanzhou Fujian, 362000, P.R.China.

Objective: To investigate the effectiveness of arthroscopic talocalcaneal coalition resection in painful adults via a modified posterior approach.

Methods: Between January 2015 and December 2017, 9 patients with painful talocalcaneal coalition accepted arthroscopic resection via the posterior malleolus high lateral observation approach combined with the lower medial operation approach. Of them, 6 were male and 3 were female, aged from 19 to 30 years (mean, 24 years). Read More

Int J Paleopathol 2020 03 5;28:32-41. Epub 2020 Jan 5.

The Ohio State University, United States. Electronic address:

Objective: The objective of this study is to estimate the frequency and types of tarsal coalition represented in medieval remains from Exeter, England.

Materials: 183 individuals from the Cathedral Green site in Exeter, England.

Methods: Gross macroscopic analysis combined with radiographic examination and comparison with clinical and archaeological literature. Read More

Zhongguo Gu Shang 2019 Nov;32(11):1057-1062

The 6th Department of Orthopaedics, Guangdong Province Hospital of Traditional Chinese Medicine Zhuhai Branch, Zhuhai 519015, Guandong, China;

Objective: To explore CT imaging features and reason for missed diagnosis of clinical practice of occult anterior calcaneal process fracture.

Methods: From July 2013 to November 2018, the clinical data of 13 patients with occult an anterior calcaneal process fracture were retrospectively analyzed, including 2 males and 11 females, aged from 22 to 54 years old. Classification of fracture, displacement of fracture, direction of fracture line, size of fracture, with or without tarsal coalition, other fractures and misdiagnosis, the time from injury to diagnosis, condition of treatment and fracture healing were observed according to case history, data of X-ray and CT. Read More

Curr Opin Pediatr 2020 02;32(1):93-99

Hospital do Trabalhador, Curitiba, Brazil.

Purpose Of Review: Tarsal coalitions may cause painful pes planovalgus and recurrent sprains, and can lead to arthrosis if improperly managed. In this review, we discuss the current topics related to talocalcaneal and calcaneonavicular coalitions.

Recent Findings: Tarsal coalitions are initially managed with conservative therapy, and when this approach fails, surgery is performed. Read More

Skeletal Radiol 2020 May 29;49(5):699-705. Epub 2019 Nov 29.

Department of Radiology; Division of Musculoskeletal Imaging and Intervention, Virginia Commonwealth University Medical Center, 1250 E Marshall St, Richmond, VA, 23298, USA.

Objective: The purposes of this study was to determine the prevalence of the accessory anterolateral talar facet (AALTF); to evaluate the relationship between AALTF, focal abutting bone marrow edema (FABME), and sinus tarsi edema; and to study the prevalence of tarsal coalitions in patients with the AALTF utilizing ankle MR images.

Materials And Methods: 5-T ankle MR images were reviewed for the presence of AALTF, FABME, sinus tarsi edema, tarsal coalition, and location and type of coalition (cartilaginous, fibrous, and osseous). Multivariate analysis was performed to examine the correlation between AALTF and the other variables. Read More