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March 21, 2026Open Access

Talocalcaneal Coalition: Current Concepts, Clinical Implications, and Management Strategies

AMAntonio MascioUniversità Cattolica del Sacro Cuore CCChiara ComisiUniversità Cattolica del Sacro Cuore VCVirginia CinelliUniversità Cattolica del Sacro Cuore

Key Points

The aim is to synthesize current concepts, clinical implications, and management strategies for talocalcaneal coalition.
Narrative review of current concepts and clinical presentations of talocalcaneal coalition.
Analysis of imaging modalities including CT and MRI for diagnosis.
Discussion of conservative treatments and surgical interventions like coalition resection and arthrodesis.
Critique of emerging diagnostic pathways, especially weight-bearing CT.
Improved recognition of talocalcaneal coalition due to advancements in imaging techniques.
Diagnosis relies on integrating clinical findings with imaging results, particularly CT and MRI.
Evidence indicates the effectiveness of various management strategies, including conservative treatments and surgical options.
Highlighting the need for standardized imaging criteria to enhance treatment outcomes.

Abstract

Talocalcaneal coalition is a frequent cause of painful rigid flatfoot in adolescents and young adults, resulting from congenital failure of segmentation with fibrous, cartilaginous, or osseous bridging of the subtalar joint. Clinical presentation typically coincides with skeletal maturation and includes hindfoot pain, recurrent ankle sprains, progressive stiffness, and characteristic planovalgus deformity. Although prevalence is likely underestimated, advances in imaging have improved recognition and characterization. Diagnosis relies on the integration of clinical findings with imaging, where computed tomography (CT) remains the reference standard, while magnetic resonance imaging (MRI) enables accurate detection of both osseous and non-osseous coalitions and associated soft-tissue changes. This narrative review aims to provide a comprehensive and updated synthesis of current concepts in talocalcaneal coalition, with specific focus on its clinical implications and contemporary management strategies. We critically analyze diagnostic pathways, including emerging modalities such as weight-bearing CT, and discuss evidence-based indications for conservative treatment, coalition resection, and arthrodesis. Particular attention is devoted to patient selection, prognostic factors, and evolving minimally invasive techniques. Current limitations and areas of controversy are highlighted, emphasizing the need for standardized imaging criteria and optimized treatment algorithms to improve long-term functional outcomes.

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