Tarsal coalition

A Tarsal coalition is a solid bridge between two or more bones of the rear and midfoot, which can be formed by fibrous tissue ( fibro ) cartilaginous or bony, where normally a movable joint is created. A bony tarsal coalition is also known as synostosis. A tarsal coalition can occur in isolation, then only two bones are usually connected, or it involved several bones in a multiple coalition, which is observed more in the context of a malformation syndrome.

The exact etiology is unknown, it is believed a lack of differentiation of the mesoderm on. Multiple forms are closely related to other differentiation disorders of the extremities. Exogenous risk factors have not been described.

Isolated forms

The isolated forms can be a chance finding, so be never symptomatic. In an earlier study of soldiers to an unknown tarsal coalition in 1% showed without any complaints. The ever-present limitation of movement often does not fall on.

In general, however, occur on exercise-induced pain in the rear and midfoot during growth, often with a Knicksenkfußstellung and occasionally with a painful spasm of the peroneal muscles on the outer side of the ankle. Rarely there is a full expression of a rigid massive Knicksenkfußes.

The test has been done with 45 ° oblique radiographs of the hindfoot, as the oblique and complex shaped lower ankle and the Chopartgelenk are usually to recognize not respond well to the standard shots. Better is a computed tomography.

In a symptomatic tarsal coalition, there is a therapy in which surgical resection, with or without interposition of adipose tissue. There are described recurrences in up to 10%, the results of resection, however, are usually good.

The different shapes are often symptomatic at a different time:

  • Kalkaneo - navikuläre coalition (53%) between calcaneus and navicular often the first symptoms between the ages of 8 and 12 years. Significant movement in the subtalar joint is rigid with often planovalgus.
  • Talokalkaneare coalition (37%) between talus and calcaneus. Symptoms usually occur only in adolescence or later. Also with rigid Knicksenkfußstellung and significantly reduced mobility of the subtalar joint.
  • Talonavikuläre coalition between the talus and navicular bone, partially symptomatic from the age of three. Usually the inside of the foot is clearly seen to cause often without discomfort. The longitudinal arch is preserved in this form often.
  • Calcaneocuboid coalition (rare) between calcaneus and cuboid
  • Navikulokuneiforme Coalition ( rare) between the scaphoid and a sphenoid

Multiple forms of

These are often part of a syndrome with other differentiation disorders of the extremities, as in:

  • Dysmelias and longitudinal deformities
  • Fibuläre hemimelia: In a study to investigate the resected by amputation was found in 54% talokalkaneare a coalition.
  • Proximal focal Femurdefekt ( PFFD )
  • Apert syndrome
  • Carpal coalition, ie the fixed connection of the carpal bones
  • Kugeltalus
  • Symphalangism

Treatment depends usually on the underlying disease. If tarsal coalition over a simple fusion of two bones addition, a reconstruction is usually not possible, so that more complex methods are used for deformity correction. The goal is a real position of rear and midfoot without pain, movement restriction remains up for stiffening.

Congenital disorder Recidivism (medicine)
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