Presentation,Treatment,and Outcome of Tarsal Coalitions in Dancers

Abstract

Tarsal coalitions, a fusion between two or more bones of the tarsus, are a rare entity in dancers and may easily be missed. We describe the presentation, types, and treatment of tarsal coalitions in six female dancers and one male dancer (age range: 10 to 26 years) diagnosed between 2008 and 2011. The presenting complaints were ankle pain, a sense of instability, a painless foot deformity (hyperprona-tion), and difficulties and pain with plantar flexion and toe standing (pointe or demi-pointe). Physical examination revealed a stiff subtalar joint in all cases. Three patients with a calcaneo-navicular coalition were treated successfully by resection of the coalition with interposition of the extensor digitorum brevis or gelatin sponge. Four patients with a talo-calcaneal coalition were treated conservatively with a custom made insole for activities of daily life in combination with exercises for the ankle muscles. Three of these four dancers were able to continue their careers in dance with only minor limitations. In all, six of our dancers with a tarsal coalition were able to continue dancing. Treatment in dancers depends on the type and extent of the coalition. In calcaneo-navicular coalition, early resection of the “bar” is our treatment of choice, which is based on historic reports in the literature and our success with three patients. In our opinion the only option for talo-calcaneal coalition in dancers is conservative treatment.