by Brett D. Sachs, DPM
Some things you know from the moment your child is born: all fingers and toes accounted for, an angel kiss on the back of the neck, looks like grandpa’s ears or nose. Others you will find out as you go along: he has your temper or she’ll be long-limbed like her dad. One thing that appears in some kids as they start to mature is tarsal coalition in their feet. It has actually been there all along, but as the bones harden it starts to make its presence felt. Here’s what happens to cause this pain by the ankle.
Bones Joined at Birth
The condition is genetic—a gene mutation changes how the tarsal bones form at the back of your child’s foot. The tarsals most often involved are the heel bone (calcaneus), the talus that nestles on top of it, and the navicular bone just ahead of the talus. A connection of cartilage, scar-like tissue, or bone develops between them.
At first, when your child’s tissues are soft and malleable, this does not usually cause problems. You might not be aware of any difficulty unless the tarsal coalition showed up on an X-ray for some other problem. As he or she begins to mature, however (at about age 8 and beyond), the bones and tissues become harder, and that’s when problems can appear. In some cases, your child’s foot hurts because the joined bones can’t move as they should. Not all children with this condition end up with foot pain, but it is estimated that about half do.
Indications of a Foot Problem
Here are symptoms to watch for:
- Your child complains of pain by the ankle or the top of the foot just in front of the leg.
- He or she may have flat feet when standing that remain flat even when rising on tiptoe.
- His or her foot feels stiff and can’t move up and down or side to side very well.
- Your child may experience frequent ankle sprains, because the rigid foot makes it harder to balance on uneven surfaces
- He or she may develop a limp, complain of more pain after activity, or just lose interest in being active.
If any of these describe your child, bring him or her to our office for an evaluation. We will gather the medical history and thoroughly examine the affected feet—including imaging tests like an X-ray or CT scan if needed—to see whether tarsal coalition is present and causing the foot pain.
Treatments for Joined Foot Bones
As we said before, this condition may not cause any problems in your child, so unless there is pain or limitation on activity, no treatment is needed.
If it is a problem, we will try conservative methods first to take care of it. These may include resting from activity that puts stress on the bones for a few weeks until the pain subsides. A boot or cast may be recommended to keep the foot immobile during this time, and sometimes orthotics can help as well to keep the bones stable and relieve pressure on them. We will also discuss any needed pain relief medication that is appropriate.
If these methods do not resolve the problem and your child’s foot still hurts, know that you have come to the right place if he or she needs surgery. Dr. Matthew Paden, Dr. Brett D. Sachs, and Dr. Dustin Kruse are expert surgeons and caring podiatrists who will take the time to explain the procedure, help you decide what is best, and guide your child’s recovery period—including any rehab that will be necessary. Don’t let your son or daughter suffer needlessly with foot pain. Schedule an appointment at one of our west Denver area offices today by calling (303) 423-2520 or using our online request form.