Coalition and sports

When an adolescent athlete presents with pain in the foot and ankle region, the diagnosis of tarsal coalition should be considered. Tarsal coalition is a congenital anomaly characterised by bony, cartilaginous or fibrous union of the bones in the hindfoot and midfoot. Most such coalitions are talocalcaneal or calcaneonavicular. Pain, peroneal spasm, rigid flatfoot, and a bony prominence inferior to the medial malleolus are typical signs and symptoms of such a coalition. The diagnosis can usually be made by plain X-ray. MRI, CT, and SPECT-CT are additional useful diagnostic modalities. In talocalcaneal coalition, the C sign and talar beaking are frequently visible in a lateral radiograph. Oblique radiographs of the foot are useful for detecting calcaneonavicular coalition. If conservative treatment such as reduced activity and cast immobilization is ineffective, excision of the coalition should be considered.