Introduction

Tarsal coalition is an abnormal condition that affects the bones in the back of the foot and heel, making walking difficult.¹ Tarsal Coalition is often seen in individuals who participate regularly in sports and other athletic activities.

It is estimated that one in every hundred people has a tarsal coalition.¹ The condition affects both feet in almost half of the cases.¹

This article examines the impact of tarsal coalition on sports, athlete performance, and potential solutions to control this disease.

What is the tarsal coalition?

To understand tarsal coalition, we must first understand what happens within the foot, the anatomy (internal structure of the foot, such as bones), and physiology (how it functions). 

The foot bones are classified into three categories: hindfoot, midfoot, and forefoot.¹ Additionally, the hindfoot and midfoot are made up of seven unevenly formed tarsal bones.¹ In individuals with tarsal coalition, an abnormal connection known as a coalition arises between two or more tarsal bones in the foot, resulting in a painful, rigid flat foot.⁵

Although these symptoms are commonly present from infancy, they can also appear in early adolescence or maturity.¹ Fractures, tumours, infections, and arthritis can all cause them.² Furthermore, tarsal coalition can have a severe influence on athletes, potentially resulting in long-term harm or danger of injury.

Symptoms

Unfortunately, tarsal coalitions rarely show any symptoms.³ In some cases, symptoms start developing once a person reaches adolescence or adulthood.³ Typically, it begins in the centre or rear part of the foot.³

Possible Tarsal Coalition symptoms include:  

• Pain or stiffness⁴
• Difficulty walking due to flat feet⁴
• Pain during walking, running and increased weight bearing⁵
• Ankle sprain/trauma⁶
• Fatigued legs⁷

Diagnosis

The basic diagnostic method is to take radiographs. Magnetic resonance imaging (MRI) is useful for imaging soft tissues and obtaining a detailed view of the bones. X-rays and CT scans may also be beneficial.¹ Furthermore, regardless of the scenario, a clinical examination is performed first in the diagnosis, where the practitioner examines the stiffness or stress that has occurred in the bones.⁹

Impact on athletic performance
Since tarsal coalition affects the foot, which is an important part for an athlete, the influence on them is critical.

Limited range of motion

Adolescent athletes with tarsal coalitions typically present with symptoms such as foot and ankle soreness and restricted range of motion.⁸

Injury or ankle sprain 

When an athlete continues to play sports despite their condition, they may develop recurring stress fractures, which can contribute to the development of tarsal coalitions.

As a result,  present and prior athletic efforts may significantly contribute to the exacerbation of tarsal coalition and its persistent symptoms.

When an ankle sprain is dismissed as a simple thing, it may be linked to the tarsal coalition and increase the likelihood of recurring injuries.⁵ Ankle fractures influence the development of a tarsal coalition over time.⁵

Pain during sports activities

Tarsal coalition is a stable condition that is not a direct source of foot pain. However, the hardening of the bones or tissues at the coalition location restricts normal joint motion and causes discomfort.⁵ Foot mobility and movement become uncomfortable due to the gradual stiffening at the coalition, and can be mechanically adjusted depending on the level of discomfort.⁵

Treatment

The most important thing to consider while treating a patient is to improve their quality of life and restore regular activities. If the patient is not experiencing pain or symptoms, no treatment is necessary.⁹ If treatment is required, there are surgical and nonsurgical options.⁴

If the patient is experiencing mild symptoms, NSAIDs, foot orthotics, 6 weeks of casting, and foot supports appear to be useful.^{3, 5, 6} Casting is the most effective conservative mode of therapy; however, none of these options provides long-term relief.⁵ Physiotherapy can also aid with muscular strengthening and stretching. It can be challenging for athletes to rest for a week, but experts typically recommend resting for 3-6 weeks to enhance recovery.¹

When the pain is too severe and causes mobility constraints, the next stage of therapy is surgery; however, surgery is always dependent on each patient's specific characteristics. The options would be to remove the coalition between bones and rebuild the foot's flatness.^{1, 4}

Post-treatment recovery goals

Suppose you have undergone any type of therapy, whether surgical or non-surgical, the restoration of health and mobility is examined first. Because the body has undergone multiple treatments or surgeries, it will be at its weakest and will require physiotherapy or exercise to recover its natural strength. As an athlete's recovery continues, mobility, strength, endurance, and sport-specific workouts are incorporated to prepare for a progressive return to competition.¹⁰

Strengthening the muscles and bones with exercise helps speed up recovery and gets an athlete back on track quickly. Aside from surgery or pain-related rehabilitation, refining sport-specific abilities, balance, and agility are also essential for the athlete's safe recovery.¹¹ Furthermore, rehabilitation services help an athlete's body adapt to the demands of their activity, lowering the chance of injury.¹¹

Prevention is better than a cure. It is always preferable to be aware of the possibility of re-injury and to practice safely since athletes face this danger more frequently, and it may be unavoidable.

Summary

Tarsal Coalition is an uncommon condition that can have a quiet impact on people, particularly those who participate in sports and athletics. Although many patients remain asymptomatic, the condition can eventually cause pain, stiffness, ankle sprains, and difficulty moving. For athletes, this condition presents a considerable difficulty because the feet are critical for performance and movement. From diagnosis to imaging and clinical examination to treatment—whether conservative or surgical—the goal is the same: to enhance the patient's quality of life and enable them to resume regular activities.

Post-treatment rehabilitation is critical in regaining strength, mobility, and sport-specific abilities. Because prevention is always preferable to cure, athletes should be aware of injury risks and adopt the right techniques to avoid re-injury. With the correct techniques and care,  athletes with tarsal coalitions may still achieve their objectives and maintain a healthy level of performance.