Examination and management of a patient with tarsal coalition

The purpose of this case report is to illustrate how the literature can be used to guide clinical decisions related to a relatively uncommon pathological condition of the foot. This case report describes the approach used to examine and treat a 14-year-old boy referred by a physician for physical therapy with a diagnosis of peroneal spastic flatfoot (PSFF). Peroneal spastic flatfoot is a syndrome typically characterized by limited tarsal joint motion, a clonus response of the evertors, and a pes planus deformity. The patient reported having a limp for several years, but he said he was pain-free until he had an inversion injury of his foot. Because the physical therapists had not seen a patient with a diagnosis of PSFF, they reviewed the literature related to PSFF. They describe how their review enhanced their understanding of PSFF and how PSFF is related to the diagnosis of tarsal coalition, a pathological condition eventually identified in this child. Following 5 unsuccessful physical therapy sessions, they referred the patient to another physician who diagnosed a talocalcaneal coalition, a type of tarsal coalition.