Tarsal coalitions. A new surgical procedure.

Coalition is a congenital fusion of two or more tarsal bones. Symptoms, if present, usually begin in early adolescence. The typical symptom complexes are aching pain in the rearfoot exacerbated by activity, progression of the flatfoot deformity, decreased tarsal motion, and sometimes peroneal spasm. When patients are asymptomatic, no treatment is necessary. If symptoms begin, the individual should be treated conservatively. If that fails, surgical intervention should be undertaken. Calcaneonavicular coalitions respond well to excision with extensor digitorum brevis interposition. Talocalcaneal middle facet coalitions have responded well to resection with implant arthroplasty. When degenerative changes are present in the subtalar and midtarsal joints, triple arthrodesis is still the procedure of choice.