Dr. Kevin Yip

Dr Kevin Yip
Orthopaedic Surgeon
MBBS(UK), FRCS(EDIN), FAM(SING), FHKCOS(ORTHO)

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Tarsal Coalition

SYMPTOMS

There is diffuse exercise-induced aching pain around the sub-talar joint, sometimes after previous sprain.

AETIOLOGY

The aetiology is unclear. Sub-talar structures fuse over time by fibrosis or callus formation.

CLINICAL FINDINGS

There is tenderness on palpation over the sub-talar joint (sinus tarsi), decreased mobility and swelling.

INVESTIGATIONS

X-ray may show talo-navicular coalition; talo-calcaneal coalition requires MRI or CT scans.

TREATMENT

Initially try orthotics to support the foot arch. NSAID or local cortisone injections can give short-term relief.

REFERRALS

Refer to podiatrist or physiotherapist for mild symptoms and to orthopaedic surgeon if symptoms are severe. Surgery may involve fusing the joints or excision of fibrosis but is not always successful.

EXERCISE PRESCRIPTION

Rest will not help so allow all kinds of sporting activities, using well fitting shoes and avoiding impact. If there is pain on impact suggest low-impact activities such as cycling and swimming.

EVALUATION OF TREATMENT OUTCOMES

Monitor the decrease of clinical symptoms and signs.

DIFFERENTIAL DIAGNOSES

Tumour (X-ray and MRI will differentiate); Stress fracture (X-ray and MRI will differentiate); Sub-talar pain syndrome.

PROGNOSIS

Good-Fair with or without surgery.

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