So glad to have found this thread. We noticed in kindergarten that my son walked and ran differently but were put off on it until age 9. He has pain when running, or jumping, occasional spasms, but no limping or constant pain. Our 1st opinion doc did x-rays and said no problems, wear inserts. After a year, we've gotten a 2nd opinion and this doctor says from x-ray he suspects coalition. We had the MRI and I was able to pick up our results today. It just says No Abnormalities demonstrated. I am confused as to how X-ray could show a coalition but MRI not show it?? I am frustrated. Were your children's coalitions diagnosed by XR or MRI? Of course, the foot doctor may read the MRI himself before our appointment next week, and I thought maybe he wanted to MRI to check the ligaments more than the bones... I don't know. I would just love a clear answer so we can get this resolved. What would you do? Thanks
We were diagnosed with MRI. My son later needed a CTScan - I was told this was the best way to see it. After surgery we were told the coalition was even bigger than the CTScan showed. My son was age 7 at the time. His coalition was fibrocartilage when diagnosed. I suspect it would have ossified as he aged and would have been better visible on XRay. XRay shows bone. MRI does show the ligaments and tendons, but also cartilage. CTScan is not with risk/radiation exposure.
You will know more when the MD reads the MRI. I would make sure you consult with a pediatric ortho MD. When you say foot doctor you don't mean podiatrist do you?
I can greatly appreciate what you (and others reading this thread) are going through...
I am certainly no expert but am happy to share my son's story...maybe it will help someone:
My son is very active - has been playing ice hockey since age 5... and baseball/lacrosse during off season.
Spring/Summer of 2011 started to notice very flat, turned-out feet in my then-10year old son. Never any pain, no sprains....just flat, splayed out feet
Brought him to doctor in the Fall- thinking he would be getting orthotics....doc sent us for MRI ...diagnosis T-C coalition in both feet (not yet ossified, no arthritis)...
Doc recommended surgery...and after exhaustive research, I agreed... the coalition was obvious..
First foot was operated on Feb 23, 2012 Post -op course of treatment: 5 weeks in a non-weight bearing cast followed by about 2 weeks in a walking boot. PT began when out of cast....
Second surgery was done June 1, 2012... same post-op plan.
We were VERY careful after surgery - very little movement (he slept on couch so he would not have to go up stairs at all for the first week, used a wheel chair so there was no chance of slipping with crutches, even used a hospital potty so he would not go all the way to the bathroom .... fortunately, we home-school, so he was able to keep up with school work right from the couch).....
We were told to expect some pain after surgery...but there was very little - my son did not take any pain med's post op (again - he really did not move much at all...but we wanted to do everything we could to avoid needing pain meds)...the only time he took the Rx motrin was before he went in to have the cast and stitches removed at 3 weeks post op..
He is now at 25 weeks since the first surgery and is doing great.... PT is just about over... still walking a bit stiffly, but no pain...he was outside playing basketball with his friend today! He will be back on the ice in about a week.
I told the doctor when this started that he had 26 weeks to fix my son's feet...and we have just about made it!
Hope this helps! Good luck!
Yes, this was a regular podiatrist we saw. I am taking him to see a pediatric ortho doctor too, but we have not had that appointment yet. We started with podiatry at our pediatrician's recommendation. The MRI reading came back normal in every way, which doesn't make any sense to me, since obviously something isn't right with his feet, unless maybe something is off higher up, like hips or knees. The podiatrist recommended orthotic shoes for a few years, then re-evaluate. I want him to be able to run and play, so waiting a few years isn't really what I wanted to hear, since we told that when he was in kindergarten and he hasn't gotten better. I wasn't sure how far we'd have to travel to see a pediatric doctor, but I found one pretty close! Hoping to get in to see him next week. I'll update then! Do you think they will re-read his XR and MRI or order more tests, or what?
Hi my son had been diagnosed with tarsal coalition at Mass General. I'm really not happy with the direction they went in. I am going to call Boston Children's but we have a short window since he is now 18, and you can only go there till you are 19. He is in so much pain, and it was discovered after he had to quit lacrosse, which he loves, now he works in retail, as well as attending his senior year in high school. He is really active, and has a very high tolerance for pain. I'm so nervous that he's messing up his body by continuing to shift his weight of his bad ankle. Any suggestions on specific Dr's at Children's? Thanks so much. Also did any of your children walk later then usual. My son didn't walk till he was 15 months. I thought this was normal since he was the third, and my daughter carried him everywhere, now I wonder.
I don't have any great advice on doctors, but I did want to respond. I think at his age, a pediatric or regular orthopaedic surgeon would be fine though. My son was not a late walker, but we also do not have a confirmed coalition diagnosis yet. Best regards
Sorry I didn't see this sooner. We saw Dr Spencer at Children's. I can't say enough good about her. Good Luck. My son was not a late walker (10 months). But always had a "funny" gait pattern when running.
Hi I looked online for 'supports groups' for people with Tarsal Coalition, and found this site. It's a mothering site but I have no children..I'm 19 and I was diagnosed with talocalcaneal tarsal coalition over the summer. It's weird that it would only start bothering me now, but it is what it is I suppose. I tried wearing an air cast and orthopedic inserts, even had laser therapy, but when I went back to college the distance I was walking stunted the recovery process. I started using a cane a week ago because of the pain..now I have a walking boot. I'm in PT for the ligaments on the bottom of the foot that is effected. My arch collasped causing the damage. I'm in pain all the time and can't take anything for it because the naxproxen I was taking gave me ulcers that I am now being treated for. I want to try all the conservative options first if anyone has suggestions for other treatments I could try please let me know :)
So sorry you are having so much pain. I can't think of any other conservative approaches. Sounds like you have tried many. My son did not have a positive response to conservative treatment. With the exception of orthotics providing some pain relief. He did have a positive response to surgery, but was much younger at the time.
Hope you find relief.
I am in a similar position in that I have no children but do have tarsal coalition myself. All I can say is try and do what ever it takes to get it sorted early. It took 8 years of doctors, physio, chiropodists, injections and scans before I was diagnosed at 33. I had an op which didnt work and now I have back pain, arthritis in my knees and still pain in my ankles. The earlier you can sort this the better
Hi We are now 4 weeks post surgery and my son is swimming, running and cycling as normal. No limp whatsoever. If it wasn't for 10cm scars on each foot you wouldn't have known that he had had anything done. His feet are also slightly flatter than before.
Apart from swimming he kept his feet up for the first 2 weeks, rotating and stretching them every half hour or so and after that was allowed to walk as much as he wanted. We used a wheelchair for the first 3 weeks and he has walked without any support since then.
My surgeon can't understand why you would immobilise the feet when the last thing that you would want is for the bones to heal together. He says he never put any sort of cast or moon boot on tarsal coalitions patients are they usually fully mobile again within 6 weeks.
I was really glad I paid to get the operation done as soon as possible, although after reading lots of comments on forums I was very apprehensive. It turned out to be less painful and a faster recovery than a broken ankle. The cost over here was $8200NZ
My advice would be to get it done asap!
I am very glad I found this site, would love to hear from people that had the surgery done and how their kids are doing?
Our advice would be to get it done as soon as possible. The longer you leave it the higher the chance of long term problems caused by arthritic changes to the other bones in the foot. My son broke his 5th metatarsal a few weeks ago so had to have X rays of his right foot. This meant that we got the opportunity to have a look at the bones that were operated on. They have healed beautifully and apparently now look no different to a normal foot.
My son loves being able to rotate his feet fully and is now swimming and running MUCH faster than before the operation. As the stiffness creeps up gradually he didn't realise just how limited his movement had become despite being a very active child participating in sporting activities everyday. He was only diagnosed due to having an injured foot that didn't respond to physio which meant that he was sent for X-Rays.
We got both feet done at once which meant that he was not really mobile for about 3 weeks but he was swimming 3 days after the operation and had suprisingly little pain which was controlled with normal over the counter medication. Keeping his feet up definitely helped to reduce swelling and aid recovery time
Steroid shots will improve the pain short term but will not make any difference long term. The longer you leave it the move fused the bones will become which means the worse the surgery will be.
If you want me to email you some photos of his feet my email address is firstname.lastname@example.org
Getting the coalition separated is the best option, the idea is once separated that the bones can continue to grow in the correct way. Fusion is usually a result of a separation surgery failing, used as a last ditch effort when nothing else can be done. If your child is 12 or younger and they are suggesting fusion I would strongly suggest getting a second opinion.
Also a lot of the choices to be made with regards to surgery will undoubtedly be reflective of how severe the coalition is.
On a personal note, I was too old when I found out about my coalition to be recommended for separation surgery. My first two doctors informed me I would be in horrible pain for the rest of my life and that I could just take pain killers. Or I could get a fusion which meant I would have severely limited movement in that foot and definitely no chance of jogging again. None of my doctors recommended physical therapy. All of them told me it was a structural problem which could only be solved surgically. I pushed for the physical therapy option anyway. I worked for a year with a physical therapist building up the surrounding muscles to support my ankle and foot. Two years later I have been keeping up with the physical therapy on my own every week and am no longer in any pain. I cannot run, I cannot jump, I cannot jog. For now. But I hope at some point in the future if I continue to work hard on muscle strengthening that I will be able to. If I had gotten a fusion my chances of ever jogging or jumping would be very low to impossible. Also I wear orthotic inserts in all of my shoes and I have found this very helpful.
So in conclusion my advice is double check the fusion surgery recommendation, talk to physical therapists, and also try to access if there are any other problems besides the coalition. For example I found out I had developed plantar fasciitis from the coalition causing my arch to collapse. Such things are important to know about, because if the coalition is not so severe, then the real cause of the pain might be another cause that can be solved without surgery.
Sorry for my extremely long post! I wish you and your daughter all the best! Good luck!
Last edited by Lissy123; 03-11-2015 at 11:47 PM.
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