Next Step: Foot Care In Connecticut

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tarsal coalition is an abnormal connection that develops between two bones in the back of the foot (the tarsal bones). This abnormal connection, which can be composed of bone, cartilage, or fibrous tissue, may lead to limited motion and pain in one or both feet.

The tarsal bones include the calcaneus (heel bone), talus, navicular, cuboid, and cuneiform bones. These bones work together to provide the motion necessary for normal foot function.

Most often, tarsal coalition occurs during fetal development, resulting in the individual bones not forming properly. Less common causes of tarsal coalition include infection, arthritis, or a previous injury to the area.

While many people who have a tarsal coalition are born with this condition, the symptoms generally do not appear until the bones begin to mature, usually around ages 9 to 16. Sometimes there are no symptoms during childhood. However, pain and symptoms may develop later in life.

The symptoms of tarsal coalition may include one or more of the following:

  • Pain (mild to severe) when walking or standing.
  • Tired or fatigued legs.
  • Muscles spasms in the leg, causing the foot to turn outward when walking.
  • Flatfoot (in one or both feet).
  • Walking with a limp.
  • Stiffness of the foot and ankle.

A tarsal coalition is difficult to identify until a child's bones begin to mature. It is sometimes not discovered until adulthood. Diagnosis includes obtaining information about the duration and development of the symptoms as well as a thorough examination of the foot and ankle. The findings of this examination will differ according to the severity and location of the coalition.

In addition to examining the foot, the surgeon will order x-rays. Advanced imaging studies may also be required to fully evaluate the condition.

The goal of non-surgical treatment of tarsal coalition is to relieve the symptoms and reduce the motion at the affected joint. One or more of the following options may be used, depending on the severity of the condition and the response to treatment:

  • Oral medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be helpful in reducing the pain and inflammation.
  • Physical therapy. Physical therapy may include massage, range-of-motion exercises, and ultrasound therapy.
  • Steroid injections. An injection of cortisone into the affected joint reduces the inflammation and pain. Sometimes more than one injection is necessary. 
  • Orthotic devices. Custom orthotic devices can be beneficial in distributing weight away from the joint, limiting motion at the joint, and relieving pain.
  • Immobilization. Sometimes the foot is immobilized to give the affected area a rest. The foot is placed in a cast or cast boot, and crutches are used to avoid placing weight on the foot.
  • Injection of an anesthetics. Injection of an anesthetic into the leg may be used to relax spasms and is often performed prior to immobilization. 

If the patient's symptoms are not adequately relieved with nonsurgical treatment, surgery is an option. The foot and ankle surgeon will determine the best surgical approach based on the patient's age, condition, arthritic changers, and activity level.

If you believe have a foot problem and do not currently see a podiatrist, call one of our six locations to make an appointment.

Connecticut Foot Care Centers

Podiatrists in CT

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Equinus is a condition in which the upward bending motion of the ankle joint is limited. Someone with equinus lacks the flexibility to bring the top of the foot toward the front of the leg. Equinus can occur in one or both feet. When it involves both feet, the limitation of motion is sometimes worse in one foot than in the other.

People with equinus develop ways to compensate for their limited ankle motion, and this often leads to other foot, leg, or back problems. The most common methods of compensation are flattening of the arch or picking up the heel early when walking, and placing increased pressure on the ball of the foot. Other patients compensate by toe walking, while a smaller number take steps by bending abnormally at the hip or knee.

There are several possible causes for the limited range of ankle motion. Often it is due to tightness in the Achilles tendon or calf muscles (the soleus muscle and/or gastrocnemius muscle). In some patients, this tightness is congenital (present at birth) and sometimes it is an inherited trait. Other patients acquire the tightness from being in a cast, being on crutches, or frequently wearing high-heeled shoes. In addition, diabetes can affect the fibers of the Achilles tendon and cause tightness.

Sometimes equinus is related to a bone blocking the ankle motion. For example, a fragment of a broken bone following an ankle injury, or bone block, can get in the way and restrict motion.

Equinus may also result from one leg being shorter than the other.

Less often, equinus is caused by spasms in the calf muscle. These spasms may be signs of an underlying neurologic disorder.

Depending on how a patient compensates for the inability to bend properly at the ankle, a variety of foot conditions can develop, including:

 

  • Plantar fasciitis (arch/heel pain)
  • Calf cramping
  • Tendonitis (inflammation in the Achilles tendon)
  • Metatarsalgia (pain and/or callusing on the ball of the foot)
  • Flatfoot
  • Arthritis of the midfoot (middle area of the foot)
  • Pressure sores on the ball of the foot or the arch
  • Bunions and hammertoes
  • Ankle pain
  • Shin splints

Most patients with equinus are unaware they have this condition when they first visit the doctor. Instead, they come to the doctor seeking relief for foot problems associated with equinus.

To diagnose equinus, the foot and ankle surgeon will evaluate the ankle's range of motion when the knee is flexed (bent) as well as extended (straightened). This enables the surgeon to identify whether the tendon or muscle is tight and to assess whether bone is interfering with ankle motion. X-rays may also be ordered. In some cases, the podiatrist may refer the patient for neurologic evaluation.

Treatment includes strategies aimed at relieving the symptoms and conditions associated with equinus. In addition, the patient is treated for the equinus itself through one or more of the following options:

 

  • Night splint. The foot may be placed in a splint at night to keep it in a position that helps reduce the tightness of the calf muscle.
  • Heel lifts. Placing heel lifts inside the shoes or wearing shoes with a moderate heel takes stress off the Achilles tendon when walking and may reduce symptoms.
  • Arch supports or orthotic devices. Custom orthotic devices that fit into the shoe are often prescribed to keep weight distributed properly and to help control muscle/tendon imbalance.
  • Physical therapy. To help remedy muscle tightness, exercises that stretch the calf muscle(s) are recommended.

In some cases, surgery may be needed to correct the cause of equinus if it is related to a tight tendon or a bone blocking the ankle motion. The foot and ankle surgeon will determine the type of procedure that is best suited to the individual patient.

If you believe you have equinus and have not seen a podiatrist yet, call one of our six locations to make an appointment.

Connecticut Foot Care Centers

Podiatrists in CT

Visit our website, friend and like our page on Facebook, and follow our tweets on Twitter.