Tarsal coalition surgery removes the abnormal bridge between two tarsal bones and fills the gap with fat or muscle so it cannot re-form. It is a day-case or one-night operation. Most children are out of a boot by four weeks, walking normally by six to eight weeks, and back to sport around three months — longer when an osteotomy is added to correct the flat foot at the same time.
Through a small incision over the coalition, the bar is removed completely under direct vision, the raw bone surfaces are sealed with bone wax, and fat or the extensor digitorum brevis muscle is placed in the gap to stop the bridge re-forming. When the heel is in significant valgus, a calcaneal lengthening osteotomy is added so the corrected foot loads evenly; a tight calf is released at the same sitting.
Published series report good or excellent pain relief in roughly 80 to 90 percent of children after resection of a calcaneonavicular coalition, with lower but still favourable rates for talocalcaneal bars. The main reasons for a disappointing result are an incomplete resection, uncorrected heel valgus, or arthritis that was already established. Risks are those of any foot surgery: wound problems, nerve irritation, stiffness, and the small chance of needing a second procedure.
For an isolated resection: two to four weeks in a boot, normal walking by six to eight weeks, and sport at around three months. If a calcaneal lengthening or other osteotomy is added, protected weight-bearing lasts about six weeks and full return takes four to six months.
Rarely, and almost only when the resection was incomplete or the gap was not filled with interposition tissue. Pain that persists after surgery is far more often due to uncorrected hindfoot valgus or existing arthritis than to true regrowth.
Most people with a tarsal coalition live and work normally, and many never have symptoms at all. An untreated painful coalition can limit standing, walking on uneven ground and sport, but successful resection or reconstruction usually returns the person to unrestricted activity.
Frequently. It results from failed separation of the tarsal bones in the embryo and shows autosomal dominant inheritance with variable penetrance, so siblings with foot pain are worth examining.
Dr. Mutasem Aldhoon is a leading Pediatric Orthopedic Consultant specializing in complex lower extremity deformities. With extensive experience in advanced joint-sparing and reconstructive techniques, he is the trusted authority for severe pediatric flatfoot and neurological foot reconstructions.
