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'@@ -24,8 +24,8 @@ | deaths = }} -'''Tarsal coalition''' is an abnormal connecting bridge of [[Tissue (biology)|tissue]] between two normally-separate [[tarsus (skeleton)|tarsal]] bones. The term 'coalition' means a coming together of two or more entities to merge into one mass.<ref>English Language Dictionary, 2007</ref> The tissue connecting the bones, often referred to as a "bar", may be composed of fibrous or osseous tissue. The two most common types of tarsal coalitions are [[Calcaneus|calcaneo]]-[[Navicular bone|navicular]] ('''calcaneonavicular bar''') and [[Talus bone|talo]]-[[Calcaneus|calcaneal]] ('''talocalcaneal bar'''), comprising 90% of all tarsal coalitions.<ref>[http://www.learningradiology.com/archives2007/COW%20281-Talar%20beak/talarbeakcorrect.html LearningRadiology.com]</ref> There are other bone coalition combinations possible, but they are very rare.<ref name="vincent-et-al">Tarsal coalition and painful flatfoot, K.A. Vincent, Shriners Hospital for Children, Portland, Oregon and Department of Orthopedics, Oregon Health Sciences University, Portland, OR 97201-3905, USA</ref> Symptoms tend to occur in the same location, regardless of the location of coalition: on the [[Anatomical terms of location|lateral]] foot, just [[Anatomical terms of location|anterior]] and below the lateral [[malleolus]]. This area is called the [[sinus tarsi]].<ref name="vincent-et-al"/> +'''Tarsal coalition''' is an abnormal connecting bridge of [[Tissue (biology)|tissue]] between two normally-separate [[tarsus (skeleton)|tarsal]] bones, and is considered a sort of [[birth defect]]. The term 'coalition' means a coming together of two or more entities to merge into one mass.<ref>English Language Dictionary, 2007</ref> The tissue connecting the bones, often referred to as a "bar", may be composed of fibrous or osseous tissue. The two most common types of tarsal coalitions are [[Calcaneus|calcaneo]]-[[Navicular bone|navicular]] ('''calcaneonavicular bar''') and [[Talus bone|talo]]-[[Calcaneus|calcaneal]] ('''talocalcaneal bar'''), comprising 90% of all tarsal coalitions.<ref>[http://www.learningradiology.com/archives2007/COW%20281-Talar%20beak/talarbeakcorrect.html LearningRadiology.com]</ref> There are other bone coalition combinations possible, but they are very rare.<ref name="vincent-et-al">Tarsal coalition and painful flatfoot, K.A. Vincent, Shriners Hospital for Children, Portland, Oregon and Department of Orthopedics, Oregon Health Sciences University, Portland, OR 97201-3905, USA</ref> Symptoms tend to occur in the same location, regardless of the location of coalition: on the [[Anatomical terms of location|lateral]] foot, just [[Anatomical terms of location|anterior]] and below the lateral [[malleolus]]. This area is called the [[sinus tarsi]].<ref name="vincent-et-al"/> ==Symptoms== -The bones of children are very malleable in infancy. This will generally mean that, despite the presence of a coalition, the bones can deform enough to allow painless walking until the child's skeleton has matured enough.<ref>Mihran O. Tachdjian, ''Pediatric Orthopedics'', 1990</ref> 'Skeletal maturing' means that bone is laid down in the tissue that forms the immature bone shape gradually until adult bone is achieved at about the age of seventeen years in the feet. Other body parts reach skeletal maturity at different times. The onset of symptoms related to a tarsal coalition usually occurs at about nine to seventeen years of age, with a peak incidence occurring at ten to fourteen years of age.<ref>Mihran O. Tachdjian, ''Pediatric Orthopedics'', 1990</ref> Symptoms may start suddenly one day and persist, and can include pain (may be quite severe), lack of endurance for activity, fatigue, muscle spasms and cramps, an inability to rotate the foot, or [[antalgic gait]]. +The bones of children are very malleable in infancy. This will generally mean that, despite the presence of a coalition, the bones can deform enough to allow painless walking until the child's skeleton has matured enough.<ref>Mihran O. Tachdjian, ''Pediatric Orthopedics'', 1990</ref> 'Skeletal maturing' means that bone is laid down in the tissue that forms the immature bone shape gradually until adult bone is achieved at about the age of seventeen years in the feet. Other body parts reach skeletal maturity at different times. The onset of symptoms related to a tarsal coalition usually occurs at about 9 to 17 years of age, with a peak incidence occurring at 10 to 14 years of age.<ref>Mihran O. Tachdjian, ''Pediatric Orthopedics'', 1990</ref> Symptoms may start suddenly one day and persist, and can include pain or pressure while walking, lack of endurance for activity, fatigue, muscle spasms and cramps, an inability to rotate the foot, or [[antalgic gait]]. ==Causes== @@ -38,5 +38,5 @@ ==Diagnosis== -In a case of an adolescent with rear foot pain, the physical exam will reveal that the foot movement is limited. This is both because there is a physical blockade to movement and because the brain will 'turn on' the muscles around the area to stop the joint moving toward the painful 'zone'. [[X-ray]]s will usually be ordered and, in general, if there is enough toughness to the tissue bridge that pain has begun – there will usually be enough bone laid down to show up in an x-ray.<ref>Stephanie Cosgrove: [http://www.walkwithoutpain.com.au/tarsal-coalition-calcaneonavicular-bar-talocalcaneal-bar%20tarsal-coalition Tarsal Coalition]{{Dead link|date=June 2018 |bot=InternetArchiveBot |fix-attempted=no }}</ref> +In a case of an adolescent with rear foot pain, the physical exam will reveal that the foot movement is limited. This is both because there is a physical blockade to movement and because the brain will 'turn on' the muscles around the area to stop the joint moving toward the painful 'zone'. [[X-ray]]s will usually be ordered and, in general, if there is enough toughness to the tissue bridge that pain has begun – there will usually be enough bone laid down to show up in an x-ray.<ref>Stephanie Cosgrove: [http://www.walkwithoutpain.com.au/tarsal-coalition-calcaneonavicular-bar-talocalcaneal-bar%20tarsal-coalition Tarsal Coalition]{{Dead link|date=June 2018 |bot=InternetArchiveBot |fix-attempted=no }}</ref> More high-tech investigations such as [[CT scan]] will be required if proceeding to surgery. If the bridge appears to be mostly fibrous tissue, an [[MRI]] would be the preferred modality to use.<ref>Tarsal Coalition: A Patient's Guide to Tarsal Coalition. EOrthopod. Medical Multimedia Group, L.L.C. Date Unknown</ref> @@ -45,5 +45,5 @@ The goal of non-surgical treatment of tarsal coalition is to relieve the symptoms by reducing the movement of the affected joint. This might include [[non-steroidal anti-inflammatory drug]]s (NSAIDs), steroidal anti-inflammatory injection, stabilizing orthotics or immobilization via a leg cast. At times, short term immobilization followed by long term [[Orthotics|orthotic]] use may be sufficient to keep the area free of pain. -Surgery is very commonly required. The type and complexity of the surgery will depend on the location of the coalition. Essentially, there are two types of surgery. Wherever possible, the bar will be removed to restore normal motion between the two bones. If this is not possible, it may be necessary to fuse the affected joints together by using screws to connect them solidly. Cutting away the coalition is more likely to succeed the younger the patient. With age comes extra wear in the affected and adjacent joints that makes treatment more difficult.<ref>Stephanie Cosgrove: [http://www.walkwithoutpain.com.au/tarsal-coalition-calcaneonavicular-bar-talocalcaneal-bar Tarsal Coalition]</ref> +Surgery is very commonly required. The type and complexity of the surgery will depend on the location of the coalition. Essentially, there are two types of surgery. Wherever possible, the bar will be removed to restore normal motion between the two bones. If this is not possible, it may be necessary to fuse the affected joints together by using screws to connect them solidly. Cutting away the coalition is more likely to succeed the younger the patient. With age comes extra wear in the affected and adjacent joints that makes treatment more difficult.<ref>Stephanie Cosgrove: [http://www.walkwithoutpain.com.au/tarsal-coalition-calcaneonavicular-bar-talocalcaneal-bar Tarsal Coalition]</ref> ==See also== '