Tarsal and tarsal bones - diseases, fractures and other injuries, possible treatment strategies

The tarsus is the rear part of the foot that connects the metatarsus to the lower leg. The tarsus begins at the Lisfranc joint and is made up of the seven tarsal bones. These tarsal bones are in contact with each other via their joints and are connected to each other relatively tightly with ligaments.

Briefly explained:

• Lisfranc joint: The Lisfranc joint line is the connection between the 5 metatarsal bones and the actual tarsus. This joint line runs between the five metatarsal bones, cuboid bone and cuneiforme bones.
• Tarsus is the root of the foot.
• The cuboid bone is one of seven tarsal bones

To enable problem-free standing, walking and rolling during running movements, the seven tarsal bones must interact and function smoothly. This is the only way to ensure the stability and mobility of the foot. Most health problems arise at the junction of the tarsal and metatarsal bones.

Dr Tonio Gottlieb, MD explains:

"The foot is a part of the body that has changed from its original gripping function to a static load-bearing function. This is why foot diseases, injuries or pain and the associated health impairments usually occur where there are still "evolutionary remnants" of the original gripping function: at the transition from the tarsus to the metatarsal bone."

In this article you will learn a lot of interesting facts about injuries, diseases and treatment options for the tarsus and tarsal bones. Simply click to navigate directly to the desired topic:

The tarsus is an important part of the human foot and is used to transfer force between the lower leg and the forefoot. It therefore plays a decisive role in the movement and stabilisation of the entire body. The tarsus consists of a group of seven bones with different anatomies, known as the tarsal bones. These are:

1. Calcaneus (heel bone): The largest bone in the tarsal that forms the heel.
2. Ankle bone (talus): The bone that connects the shin bone (tibia) and the calf (fibula).
3. Navicular bone (Os naviculare ): This bone is located in the inner area of the tarsus and forms part of the arch of the foot.
4. inner cuneiform bone (Os cuneiforme mediale): One of three bones that supports the arch of the foot. 
5. Intermediate cuneiform bone (Os cuneiforme intermedium): One of three bones that support the arch of the foot.
6. outer cuneiform bone (Os cuneiforme laterale): One of three bones that supports the arch of the foot.
7. Cuboid bone (Os cuboideum): A cuboid bone located laterally in the tarsal region.

Healthy tarsal bones ensure that the foot has a stable base for standing, walking and running. The tarsal bones are arranged in such a way that they allow the foot a certain degree of flexibility. This allows it to adapt to different terrain conditions and absorb the impact load when running. The tarsal bones therefore play a decisive role in distributing the load that is generated with each individual step.

A basic distinction can be made between congenital malformations of the tarsus, acquired diseases and acute injuries:

Congenital diseases and malformations of the tarsus

• Tarsal coalitions (lat. Coalitiones) or fused foot bones

The majority of coalitions are tarsal bones that were not completely separated during embryonic development, but are connected by a bridge of bone, cartilage or connective tissue. On the one hand, this can lead to damage to the neighbouring joints. On the other hand, this bridge can become loose in the course of life and cause discomfort. The development of osteoarthritis, for example, can be the result.

• Joint misalignments/improper loading
  Congenital, abnormal joint structures or misalignments of the tarsal bones can also cause pain and discomfort. Malpositions of the foot in particular, such as fallen arches, splay feet or flat feet, can lead to tarsal pain over the course of a lifetime. 

Acquired diseases

• Overloading
  If movements are carried out beyond the normal level, pain can occur in the tarsal area.

• Inflammation
  Tarsal and tarsal bone inflammation is often a concomitant symptom of overloading. High levels of strain, such as carrying heavy loads, prolonged walking or standing, can lead to small inflammatory changes and pain in the tarsal area.

• Tarsal tunnel syndrome
  In tarsal tunnel syndrome, nerves in the tarsal area are pinched or irritated. This can lead to numbness, tingling and tarsal pain.

• Plantar fasciitis (inflammation of the tendon plate on the underside of the foot)
  The plantar fascia is a strong fascia that connects the heel to the front of the foot. If it is inflamed, this can lead to pain in the tarsus and heel.

• Arthrosis or rheumatoid arthritis
  Arthrosis of the tarsus (degenerative joint disease) can often affect the tarsus with increasing age. Rheumatoid tarsal arthritis (autoimmune disease) can also occur at the tarsus.

You can find out more about rheumatoid arthritis on this page.

Acute injuries

• Contusions, sprains and strains
  Tarsal bone contusions, sprains or strains are caused by overstretching of ligaments or tendons that stabilise and support the tarsal bones.

• Stress fractures
  Repeated stress or overuse of the foot, as occurs during certain sports or activities, can lead to small cracks in the tarsal bones.

• Fractures
  Tarsal bone fractures (fractures) can be caused by acute injuries (trauma). Jumping, falling from a great height, sports injuries (e.g. ankle sprains) or road traffic accidents can cause a tarsal bone to break. A special case is the tarsal fatigue fracture. This is a bone fracture caused by excessive, prolonged strain on the foot.

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Pain in the tarsus or tarsal bones can be very diverse. They should therefore be clarified in good time by a foot specialist. Only then can degenerative secondary diseases such as tarsal or tarsal bone arthrosis be prevented. But which symptoms or pain can be attributed to the tarsal or tarsal bone?

Emerging pain at the tarsus is not always clearly recognisable as such. This is also due to the different causes.

• In the case of congenital malalignment of the tarsus, the malalignment itself, but also the neighbouring areas, can cause pain.
• In the case of acquired deformities, e.g. due to chronic overloading, the symptoms can also occur in another part of the foot. For example, the patient may complain of a deformation of the toes, which is actually caused by a disease of the tarsus.
• This is not the case with acute injuries to the tarsus or tarsal bones: After a trauma, the pain is felt exactly where the injury occurred. The ability of the foot to bear weight is often impaired and the tarsal bone hurts when walking.

What are the typical symptoms caused by the tarsus or tarsal bone?

The symptoms that occur may differ in congenital and acquired tarsal disorders and tarsal malformations compared to acute tarsal injuries.

Symptoms due to congenital and acquired tarsal diseases and tarsal malformations:

• The symptoms come on gradually and are rather diffuse
• In most cases, the pain does not occur at the tarsus itself 
• Symptoms are often also load-dependent
• Overloading can also lead to inflammation
• Nerve irritation may occur

Symptoms that usually occur with acute tarsal injuries:

• Swelling
• Limited mobility
• Functional restriction or limitation of resilience
• Nerve irritation can occur

If you have complaints in the hindfoot, it is advisable to consult a specialist or foot specialist straight away. The procedure for a visit to Dr Gottlieb, MD usually looks like this:

1. Diagnostics begins with a detailed discussion between doctor and patient.
2. A careful physical examination is then carried out to determine which movements cause pain in the tarsus or individual tarsal bones and which movements may only be possible to a limited extent. 
3. A foot platform with a transparent tread is helpful here. This allows the foot and leg axis to be assessed at the practitioner's eye level and the analogue footprint to be evaluated.
4. The feet are examined both under load, i.e. standing, and unloaded. 
5. This is usually followed by an imaging examination (X-ray) to confirm the diagnosis. 
6. Finally, Dr Gottlieb will discuss the diagnosis, possible causes and treatment options with you and recommend a stringent course of action.

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The choice of a suitable treatment strategy always depends on the individual diagnosis and the specific circumstances of a patient. Only a foot surgeon can recommend a customised treatment strategy based on a thorough examination. Early treatment is always recommended as it can help to alleviate symptoms and prevent long-term damage. Depending on the underlying cause of a tarsal disease or injury, there are various treatment options.

In principle, two treatment approaches are available, which must be individually adapted to each case:

1. reduction of the load

• Conservative therapy is used to immobilise the foot in various forms and dosages, e.g. with a plaster cast or with smaller to larger orthoses (from insoles to boots)

2. increase in resilience

• With physiotherapy as conservative therapy
• It is also possible to control the symptoms with medication
• With surgical therapy to improve the statics: 
  • Nerves can be released or removed in the event of nerve constrictions
  • The synovial membrane can be removed in rheumatoid arthritis
  • Reorientation of the bony components of the foot skeleton

When is tarsal or tarsal bone surgery no longer an option?

The decision in favour of tarsal surgery is always a case-by-case decision and a risk assessment. If conservative treatment methods are no longer effective, pain symptoms have been present for a long period of time or a deterioration in the statics is to be expected, tarsal surgery may be necessary. Surgery may also be unavoidable in the case of acute, severe injuries or a degenerative disease such as advanced tarsal arthrosis.

Dr Tonio Gottlieb, MD:

"Tarsal surgery is always advisable if it results in a more stable situation and prevents the risk of secondary conditions such as tarsal arthrosis. Conversely, this means that surgery can no longer be avoided if the risk of secondary disorders is 100 percent."

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The healing process after tarsal surgery varies depending on the type of procedure and the patient's individual constitution:

Immediately after the operation, the foot is usually immobilised with a plaster cast or splint to ensure the stability of the foot. The patient requires walking aids for a certain period of time to relieve the operated foot. 

Physiotherapy is also used to restore the mobility and muscle function of the foot. Targeted physiotherapy exercises are continued over several weeks. The healing process varies from patient to patient and depends on the type and extent of the procedure.  

The healing progress should be monitored with regular visits to the doctor. 

How long will I be on sick leave after tarsal surgery?

The downtime for a tarsal injury depends on the type and extent of the injury and the patient's occupational activity (standing, sitting, etc.). At Dr Tonio Gottlieb's practice, you will receive personal care throughout the entire process. Dr Gottlieb not only performs the operation, but also supports you in his practice during the entire healing process. Thanks to an affiliated physiotherapy consultation, you can receive close and personal care throughout the entire recovery period.

Healthy feet are the best basis for an active lifestyle. That's why it pays to strengthen your foot bones and joints with a balanced diet rich in calcium, magnesium and vitamin D. 

Regular foot exercises and sports that are easy on the joints, such as swimming or cycling, strengthen the muscles and flexibility of the foot. Gymnastics and foot exercises can also have a very positive effect if you have been diagnosed with tarsal arthrosis. 

Stretching and massaging promotes blood circulation and increases mobility. Walking barefoot in fine sand is also a great exercise for the feet and relaxation at the same time.

Your foot health is crucial if you want to be active in sports in the long term. Maintaining movement, fitness and mobility as you get older should be your goal in order to stay healthy.

Your feet carry your body throughout your life, which is why you should not hesitate to consult a foot specialist early on if you suffer from hindfoot pain. Only then can possible long-term consequences such as osteoarthritis be prevented. Foot surgeon Dr Tonio Gottlieb, MD, is your experienced foot specialist in south-west Berlin for all tarsal symptoms and tarsal bone pain. He always considers the entire statics of the foot and body in order to recommend a cause-oriented treatment plan.

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Through his scientific commitment, Dr Tonio Gottlieb is continuously expanding his expertise and can offer you treatment that is always based on the latest research. A timely visit to your foot and ankle specialist can make a decisive contribution to ensuring that your feet carry you well through life.  

For patients with tarsal complaints and all kinds of foot disorders, foot surgeon Dr Tonio Gottlieb, MD is your contact in south-west Berlin. As a foot specialist with deep and broad experience, he offers you a precise diagnosis and attaches great importance to cause-oriented treatment. Whether you need an initial diagnosis or a second opinion - make an appointment now for a private consultation!