Massage therapy · Kitchener–WaterlooTarsal Coalition

A tarsal coalition is an abnormal connection or joining that develops between two of the tarsal bones in the back part of the foot. The connection can be made of bone, cartilage or fibrous tissue, and can lead to limited movement and pain in one or both feet (ACFAS, n.d.).

Tarsal coalition is most often present from birth, as the bones do not separate properly while the baby is developing (AAOS, n.d.). It can run in families (Anastasio et al., 2023). Children often do not show signs of the condition until their bones mature, usually between about 9 and 16 years old (ACFAS, n.d.). Many people never know they have it (AAOS, n.d.). It may be noticed by an awkward gait or limp, a rigid flat foot, or difficulty with taking part in some sports. Less commonly, the coalition might be the result of arthritis, infection or a previous injury to the site (ACFAS, n.d.).

The abnormal connection between the two bones is known as a bar, and it can cover a small or a large part of the space between the bones (AAOS, n.d.).

Tarsal Coalition Anatomy

The tarsal bones include the heel bone (calcaneus), navicular, talus, cuboid and cuneiform bones. All of these bones work together to provide your foot with the normal movement needed to function properly (ACFAS, n.d.). There are seven tarsal bones, forming the back (hindfoot) and middle (midfoot) of the foot. Coalitions most often involve the calcaneus, talus and navicular, for example between the calcaneus and navicular, or between the talus and calcaneus (AAOS, n.d.). As the coalition turns to bone in later childhood, the foot becomes stiffer and can start to hurt (AAOS, n.d.).

How to Treat a Tarsal Coalition

Treatments you may want to discuss with your family doctor or nurse practitioner

Tips

• Muscle spasms in the leg that cause the foot to turn outward when walking need to be evaluated (ACFAS, n.d.).
• Ankle and foot stiffness are not normal and should be looked at by a medical professional.
• Pain that occurs when standing or walking might be a sign of something more serious.
• Flatfoot in either one or both feet might be an indication of a tarsal coalition (ACFAS, n.d.).

Massage can't change the connection between the bones in a tarsal coalition. What I can help with is what comes with it: tight, tired muscles in the foot and calf, a stiff ankle, and other areas working harder to make up for it. Your specialist or family doctor or nurse practitioner leads the care, and I work alongside their plan. If you've had surgery, I need your surgeon's okay before any hands-on treatment.

Please bring any X-ray or scan reports and notes from your medical team to your first visit. They're an important part of planning safe treatment for you.

I start by assessing how your foot and ankle move, how your foot behaves when you stand and walk, and the strength and flexibility of your calf.

When It's Sore

• Hands-on work for the calf, the outside of the shin and the sole of the foot, which often tighten or spasm
• Warm or cool applications in the clinic, and I'll show you how to use ice safely at home
• Cutting back high-impact activity while staying active in ways that don't flare it
• Help working out whether an arch support might help, and pointing you to a chiropodist or podiatrist for a custom orthotic

As It Settles, or After a Cast or Surgery

1. American Academy of Orthopaedic Surgeons (n.d.) Tarsal coalition. OrthoInfo. Available at: https://orthoinfo.aaos.org/en/diseases--conditions/tarsal-coalition/ (Accessed: 7 October 2026).
2. American College of Foot and Ankle Surgeons (n.d.) Tarsal coalition. FootHealthFacts. Available at: https://www.foothealthfacts.org/conditions/tarsal-coalition (Accessed: 7 October 2026).
3. Anastasio, A.T., Peairs, E.M., Grant, C. et al. (2023) 'Fracture through pre-existing tarsal coalition: a narrative review', Children, 10(1), 72. doi: 10.3390/children10010072