Tarsal coalition refers to the fusion of two or more tarsal bones as a result of the embryonic mesenchyme failing to segment and differentiate during development. This leads to abnormal tarsal joint formation.
The clinical presentation of the condition becomes more prominent during the second decade of life, with varied symptoms manifesting as the coalition gradually ossifies.
This can involve aberrant joint kinematics, subtalar stiffness, pain in the hindfoot or tarsal, flat feet and injuries to the foot and ankle complex such as recurrent ankle sprains and fractures.
According to a review conducted by Htwe Zaw and James Calder, tarsal coalition could be either congenital or acquired. The latter is rarely documented and may result from trauma, surgery, arthritis, infection and neoplasia.
The authors state that trauma could act as a trigger of a previously dormant coalition especially in coalition cases found in adulthood.
Congenital tarsal coalition is often seen in the adolescent group as ossification of the osseous coalitions usually occurs between the ages of 8 and 16 years. The underlying inheritance pattern of this type of coalition is suggested to be autosomal dominant.
Treatment strategies need to be devised after thoroughly investigating the location and extent of the tarsal coalition, the severity of symptoms and degenerative changes (if any) that may have occurred.
Lawrence et al. list out conservative measures as arch supports for minor symptoms, a short-leg walking cast for immobilisation in neutral or a slight varus position with decreased activity, and/or anti-inflammatory medications.
The inclusion of MASS4D® foot orthotics in rehabilitative programmes for tarsal coalition would be beneficial in providing constant support to the foot in its optimal posture, helping restore normal range of motion in the lower limbs.
This would facilitate the minimisation of unhealthy compensatory movements, promoting ambulation and postural alignment; this would help in protecting the individual from developing any other conditions related to the feet and body.
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Repetitive plantarflexion can lead to pain and mechanical limitation in the posterior ankle joint which is known as posterior ankle impingement syndrome. This pathology commonly occurs in ballet dancers and football players.