Tuesday, November 8, 2016

Zach's TC Story

Originally, when I published this entry, I refrained from telling my story with TC's, because I wanted to emphasize the sincerity and severity of all the experiences in the "True Stories" piece. But, recent conversations have made me re-think my approach. 

Bear in mind, however, that I'm a professional storyteller. So, while my story may read more like a short book, it is not anymore important than anyone else's.

For some time, I have been working on my own, separate piece about my personal history with TC's. It's an important story for many reasons but mainly because my story is often thought of as "worst case scenario": 43 years old, totally disabled with more than two dozen medical conditions that can all be traced back to suffering from joint and muscle pain since my first breath. 

But, then a "friend" from a Facebook group, specifically for people experiencing tarsal coalitions, either within themselves or in a loved one, reminded me of the good times I've had in my life; in spite of the pain that has plagued me all my time on Earth. So, instead of sharing my misery with you in this space, I'm going to attempt to share some fond memories and hopefully one or two pieces of wisdom along the way.  

When we are born into pain, how do we define pain? If we can't remember not suffering, how can we determine exactly how bad we're suffering? 

I never won a race in lower primary school, but although I wore leg braces until I was three years old, and I wore orthotic supports in my shoes from then on, I liked running as a young boy. I remember I had a pair of Zips tennies, which I believed made me even faster (vintage 1970's).



Once in a while, an orthotic would break in my shoe. Other times, my ankle simply locked up mid-stride, and I'd fall, but I always got back up ... every ... single ... time. 

I played basketball from seventh through ninth grade. At six-feet-three-inches tall, at age 12, I was easily the tallest kid in our conference. There was just one catch: Because of my tarsal coalitions, I was slower than most, and because I had almost no range of motion in my ankles, I couldn't jump. There were kids in my ninth-grade team, who were a full foot shorter than me, who could dunk the ball, and I could still barely touch the net, because I had no lower leg strength ... because I didn't use my lower legs to walk or run. And, although I had shin splints the entire time, and I wasn't very good, I still enjoyed most of that experience; being part of that team, despite the fact that I was the tallest bench warmer in the school's history. 

After ninth grade, I wasn't allowed to compete in school sports, because my TC's were an insurance liability for the school. So, I put all my effort into band, choir and drama; going to All-State for band on bari sax twice, for choir twice and for drama twice. Marching band was horribly painful, which was why I didn't pursue my musical endeavors my senior year. 

But, I could still walk ... most of the time. I'd had a job at a local cafe, beginning when I was 13 years old. And, although the pain nearly crippled me, I kept that job for three years; eventually changing to another restaurant job. The pain I had during each shift was noticeable, but it didn't stop me. No, the worst pain came the next day; after my muscles and tendons were allowed to relax for the night. 

 (Me in the cafe at 14 years old and 6'5" tall)

I crawled to the toilet for the first time because of TC pain, when I was 15 years old. So, instead of walking, I started bicycling; my lifelong dream being to earn a spot on the USA 7-11 team, riding side-by-side with Andy Hampsten. Thanks to my strong thighs and back, I was fast on a bicycle, too; flying at an average speed of 27 to 29 mph on level pavement and zipping by cars driving 60 mph down hills. At that time, in spite of my TC's, I was having the time of my life. 

 (Andy Hampsten, left)

But, as I was training for my first race, while speeding down a hill at around 50 mph, it became painfully clear that I just wasn't meant to be a world-class cyclist ... when I hit a dog that crossed in front of my lightweight Fuji bicycle. But, with blood dripping and skin hanging from me, my left shoulder dislocated and my helmet chin strap lodged in my throat ... I still got back up and limped to the nearest building where I saw people, who then drove me to the emergency room.  

My senior year of high school (90-91), my coordination finally caught up to my six-foot-five-inch body. And, while I couldn't compete in school sports, I became very competitive in Physical Education; wearing Nike Air Jordan high tops with my orthotics the entire time. For the first time in my life, I wasn't the last one to be picked. And, I'll never forget the time I made the game-winning catch in a PE softball game. Heck, I was even one of my school's best dancers.

At 17 years old, I followed my second dream, which was to serve in the United States Marine Corps. But, my application was denied because of tarsal coalitions. It turns out that a tarsal coalition is cause for immediate medical discharge from the armed forces. Of course, no one warned me about that, because most people have never heard of a TC, so how would they know?

That was, however, the most devastating time of my physical being; when I was forced to acknowledge and accept my real limitations for the first time. I was crushed. Not having applied myself academically, I was planning on serving in the military. And, when that dream couldn't become a reality, not much else seemed to matter. 


I barely graduated from high school; after which I became a bartender for a local pub. Two years later, I found myself homeless and hitch-hiking all over the U.S. west coast. I slept in national forest preserves, hiked near all kinds of wildlife (including bears), drank from mountain springs and skinny-dipped in crater lakes at night, under meteor showers.

In one year, I put over 1,000 miles of hiking distance on an old pair of Redwing work boots, without orthotics, and over 5,000 miles of total travel distance. And, although the pain was often extremely difficult to bear, I didn't stop. There is nothing like soaking your inflamed feet in an ice-cold mountain spring at dusk; hearing the sounds of the wilderness come alive as the cool water washes away any and all worry and discomfort. That was the second "time of my life".

 (Me after my travels)

At 25, finding myself back in my home state, with winter coming on, I decided to settle down for a while. So, I picked up a copy of the local newspaper and applied for a job therein; as a reporter for that newspaper. With no experience and no education, I was hired, because as my new editor put it, "You tell a good story, and I figure that if you can tell a good story, you can write a good story. You just need to be shown how."

And, I was a quick learner. In my first year as a journalist, I earned an honorable mention in my state's annual newspaper contest. A year later, I was offered a job as a crime writer for a larger Associated Press paper. And, after one year in that job, I earned a second-place AP award. 


 (Me, 2004)

After 2004, I hired out as a newspaper manager and editor all over my state; mostly in temporary positions. Somehow, I had what many newspapers wanted.

In my 10 years as a journalist, I lived in more than 20 different locations and had professional connections from ranging from local law enforcement to the Defense Department and everything in between. United States senators knew me by name and reputation, and my stories were re-published internationally. It was, yet again, the time of my life.


I thought I was unstoppable. I was in the big time, and I was loving every minute of it. I never suspected that something as simple as a flight of stairs could end it all.

In 2008, while working as the news editor for one of my state's dailies, I noticed a pain that had long been forgotten. My feet were inflamed for the first time in nearly 20 years. Soon after that, I experienced a surge of pain in my spine, tingling and numbness in my fingers, and my feet were swollen to nearly twice their normal size.

An MRI showed I had two bulging discs in my spine, while a CT scan showed arthritis in my feet; although the podiatrist I saw at the time had no idea what a tarsal coalition was. My primary care physician, chiropractor and podiatrist all agreed that the stairs in my building, which I climbed up and down countless times every day, were the culprit of my injuries and pain.

And, two years later, after settling the Workers Compensation lawsuit out of court, I was also approved for total Disability because of my tarsal coalitions, bulging discs and a little thing we call PTSD (which I won't get into here).

I had fallen in my life, but I was determined to get back up. So, from 2010 to 2012, I did everything I could to whip myself back into peak physical condition. In spite of my pain, I walked six miles every day, lifted weights, rode a stationary bicycle for 45 minutes, ate right, slept well and drank 3-5 liters of water every day.

By 2012, I had lost 95 pounds and was in the best shape of my life. I was ready to get back to work. But, unbeknownst to me, because I sued my former publisher for Workers Compensation, I was practically black-listed in the state's newspaper industry. Not even my friends from the biz would talk to me.

 (Me, 2012)

In 2013, I was 40 years old, hadn't worked in five years, I had no education, and because no one would talk to me, I didn't have any professional references, aside from local, state and national law enforcement officers, for an entire decade's worth of work. In spite of succeeding in the fight of my life, I had become no one special.

Realizing this and having every job application discarded without response, I sunk into a deep depression; during which I gained 60 pounds back and allowed myself to succumb to depths of mundanity. In poverty on Disability, I allowed myself to suffer. I had fallen down, but I didn't get back up.

It wasn't like I made a conscious decision to not get back up. Depression like mine is something that grows over time; sneaky and undetected, like a tapeworm. And, as my depression worsened, so did my physical condition. Numerous ailments popped up, the pain in my feet, back, neck and legs resurfaced with a vengeance.

By 2015, I had fallen so deeply into depression, I could see no way out. My medical conditions worsened and broadened. My feet also worsened, and the pain from my TC's was immeasurable.

Then, recently, in 2016, I was prescribed Levaquin and Cipro to treat an infection. Within just three days of taking the antibiotic Cipro, I couldn't get out of bed, because the pain in my tendons was so bad.

Applying my journalistic research skills, I found a medical warning from Bayer Pharmaceuticals, the manufacturer of Cipro, which reads, "Patients with pre-existing tendon issues should not take Cipro" due to a rare side effect that can result in inflamed tendons and even complete tendon rupture.

In fact, Cipro is known to cause patients with pre-existing tendon issues to be "floxed": "... the sandwiching of a DNA sequence (which is then said to be floxed) between two lox P sites"; meaning in such patients, Cipro can actually change a patient's genes, which first presents itself as an attack on the weaker tendons in the human body. And, because of my TC's, the weakest tendons in my body are the Extensor tendons, across the tops of my feet, and the Achilles tendon behind the foot, which attaches to the bottom, rear of the heel.  

The result of all this is that I am writing this chapbook from the comfort of a really uncomfortable, manual wheelchair; having lost everything of value in my life, living in poverty, with unmeasurable constant pain and no guaranteed end in sight.

I'm prescribed 18 different medications, and I have a nurse who helps me bathe. My 73-year-old mother helps me by delivering groceries and doing my laundry.

It sounds awfully depressing, doesn't it? And painful, right? Well, it is, but as I said in the beginning, if we have lived with pain all our lives, how do we know much pain we're in?

I have lived this life, with these messed-up painful feet, for 43 years. They have taken me places few people have ever been. They have supported me as I experienced so much that life has to offer. As a journalist, I saw the worst a human can do to another, and I saw the best in others.

I ran fast in my Zips, caught that game-winning fielder, was so close to becoming a professional bicyclist, hiked thousands of miles in old boots, had some pretty amazing jobs, and I became somewhat famous ...

... and today, when all my cards are down, and it seems like it's prime time to stay down, I'm getting back up.

This wheelchair isn't the end of me; only the beginning of another "time of my life". Why? Because as much as it sucks to navigate a crowded apartment in this thing, when given a straight, level surface with no obstacles, I can wheel faster than I've ever walked or run before.

So, my new goal, at nearly age 44 and even more disabled, is to whip myself back into shape, conquer this depression and as many ailments as possible and someday compete in the Special Olympics in a "sport chair" made especially for me.

 (This looks soo awesome)

One of my favorite quotes is from the movie "Shawshank Redemption" in which Morgan Freeman says, "Either get busy livin' or get busy dyin'." Well, let's just say I'm not ready to die yet; although some days, the pain is so great that I wish for it.

Is it worth it? Well, I've felt the cold, moist nose and hot, heavy breath of a bear on my cheek, while sleeping outside in the Northern Cascades, and I lived to tell about it. Does that experience outrank the pain? I think so, but maybe that's just a romantic thought from a middle-aged nobody in a wheelchair.

You tell me.


(I lived in this photo for 6 months with no shelter, at age 21. Despite lifelong pain from tarsal coalitions, I hiked 15 miles to the top and 15 miles back down.)

Tuesday, November 1, 2016

True Tarsal Coalition Stories

My first entry in this blog, "What is a Tarsal Coalition?", generated a monumental response from people suffering the effects of tarsal coalitions. In just over 48 hours, more than 1,100 people have read that article, and I have received numerous horror stories from TC sufferers.

Following are only a few of those personal accounts. Names, ages and specific locations have been changed to preserve anonymity. However, all of these experiences are real, and they prove the extent to which those with tarsal coalitions have been left to suffer unimaginable pain, while attempting to acquire adequate care through their countries' medical and governmental systems.

Remember, these are only a small fraction of real accounts from real people. If we think of ourselves as humane to any degree, these stories represent a major global injustice, and it is our duty to ourselves and others to correct how we view and treat tarsal coalitions before future generations are forced to similarly suffer lifetimes of pain.

My thanks to all who submitted their stories.

Real TC Stories from Around the World

Gillian, 45, Canada: 
"My TC is in my left foot, and I also have a similar-looking "dent" in the exact same location, only in my case it's where I had the triple arthrodesis at 14. I never used to have a dent, but it's like over 30 years the bones just collapsed.

Interesting that I've also considered foot amputation, but realize the phantom pain would probably just feel the same. I think the worst thing for me is having to explain the condition over and over to doctors, and the only reason I know as much as I do is because I did a research paper for a university osteology course.

My doctor actually told me that disability isn't for 'people like me', such is the massive misunderstanding and underestimation of this condition. If disability is not for people who've had five surgeries and a chronic, degenerative condition then who exactly is it for? People's attitudes seem to be 'Since I've never heard of it it must not be a big deal'."

Melinda, 32, USA:
"Bilateral subtalar joint coalition over here too! I think I'm going to share this. It's frustrating because people are always saying "Oh just tough it out, you're fine". My husband even compared my depressive realization that this is only going to get worse with time, not better, to how he felt when he had really bad acne in high school. Which I'm sure was an awful feeling but I can't find the idea of acne comparable to wanting to have your feet amputated."

Kris, 42, USA:
"I will live life the best I can for as long as I can. But even today, my family isn't understanding why the thought of a walk around the block is too much! It is hard for others to understand how bad the pain can get, especially when it's been raining!"

Judy, 51, USA:
"Even decent podiatrists don't have experience with this condition. When my son (then age 11) started having frequent ankle sprains, my existing podiatrist actually diagnosed him with tarsal coalitions in his left foot based on an MRI. After a month of physical therapy, he then sprained the right ankle during a PT session. MRI of the right foot also revealed tarsal coalitions. But we were told to wait until he was full grown to seek treatment because that podiatrist didn't know how to treat the condition. It turned out that was bad advice and we are thankful we didn't listen to him and sought a second opinion after a year of increased pain, more ankle sprains and stomach problems created by anti-inflammatories. It took a while to find a doctor who was experienced with this condition and had done the surgery before, but we did."

Becky, 25, Canada:

"Most podiatrists have never even heard of the condition; let alone have experience with it. I went to at least 40 podiatrists between age 11 and 19, every single one of them just told me that I was flat footed (I'm not flat footed, even with tarsal coalition) and to wear orthotics, which made the pain even worse. It took paying a whole lot of money to see a podiatrist from a different state to get an accurate diagnosis with Tarsal Coalition, and then be told that I'm not a suitable candidate for surgery but could have been if I was diagnosed earlier. This podiatrist had heard of the condition but had never actually seen anyone with it."

Nadia, 36, USA:
"I'm going to be having removing the coalition, rebuilding the arch with a graft from my hip, relocating my heel, relocating my big toe, removing a tendon. I'm worried at my age, that the surgery(s) won't work. If not that's a long wasted year hoping to recover. And if all that doesn't work and I still have pain and lack of mobility, then what? That's my right foot. Left foot will be reassessed next year. It's all so overwhelming."

Raquel, 34, USA:
"I'm in the 20% that surgery made worse. It's a gamble."

Jeanette, 55, USA:

"I think one of the problems is that it presents differently in different people and in different places. Mine is cuboid and navicular bones fused both feet, but just now at age 55 I am having trouble with my left ankle. Problems with left knee giving out since age 50."

Lacey, 22, USA:

"So I went to the dr today... All he did was put me back into a freaking cast... Wouldn't give me injections because "I'm too young" wouldn't do a mri or a ct scan because "too much radiation for someone so young and healthy" I'm so pissed off I bursted into tears crying, I'm a waitress and he expects me to walk in this walking cast no pain meds no nothing and thinks it's gonna freaking change I just got out of a cast 2 months ago.. What difference is this gonna make? I'm just so frustrated I hate this stupid foot crap. It's really been getting the best of me.

I've been in and out of the hospital since I was little because my feet would be so bad I couldn't walk, and I'd cry and my mom would feel bad. The doctors kept telling her I was lying or its just tendinitis. I didn't find out I had tc till I was 20. 

The sad part is I wanna sue my doctor for saying I was lying and misdiagnosing me and discriminating against me but honestly I feel like it would be a waste of time."

David, 35, USA:

"Anyone who doesn't believe you, drop a concrete paving slab on their foot so they can learn some empathy!"

Trevor, 31, USA:
"I know your pain!!! I have it in both feet, and experienced this as well. I was taking nearly 12-13 ibuprofens a day to lessen some of the inflammation, but I quit doing that because I was afraid if I did that too long, I'd mess my kidneys up. My orthopedic surgeon prescribed me custom made Arizona afo braces, but they didn't work. The only thing that's going to help me is surgery, but I can't do that financially right now. I tried filing for social security disability, but even though I have this crippling disability."

Tammy, 26, New Zealand:
"When I broke my ankle they wanted to operate immediately and I had to get extremely assertive . They had never heard of tarsal coalition, and I had to repeat over and over again that I was not going to be operated on because they'd open me up and find the coalition. That my foot looked weird not only because of the ankle break but principally because of the coalition."

Janice, 26, Australia:

"I am 26 years old. I was diagnosed with TC 3 years ago but I have struggled with the condition my entire life. As early as age 8 I began to experience symptoms. Some days I could run, other days I would crawl around the house because I was unable to stand up. It wasn't until 3 years ago I had a fall and started seeing a specialist. In 2015 I had a child and I feel like my symptoms have increased tremendously. I unable to keep up with my job, I have increased pain in my ankles and now my knees, hips, and lower back."

Justin, 35, USA:

"I'm 35 and have been living with foot pain since my teens. Only found out this year that I have TC and my joints are becoming arthritic. One of my ankles has rolled also. Have been getting some relief from cortisone injections every 6 mths. But having a bad day today. Sometimes the pain is so bad that it makes me nauseous and I'm always so exhausted. Barely slept last night because of it."

Joan, 26, Australia:
"My feet completed fusion on their own whilst i was pregnant with my eldest. I have 4 different types of fusions spread out over my feet. Surgery isn't an option for me and i struggle to walk most days, yet i need to walk to stay fit as i have a bulging disc in my l4-5. It hurts me that i cant do all the things i want to do with my children. Pain meds don't take all my pain away either, sometimes they don't even work. "

Brian, 28, Canada:
"Diagnosed with a coalition in my left ankle when I was 15. I did the rounds through several specialists until I was about 21. Doctors told me at 15 that I was too old for a surgical reset. And that I was likely too young for a fusion if I could help it. When I was 21 I went to see a specialist (after a two year waiting list!) who basically said if I didn't want the fusion the only thing he could do was shorten a tendon in my ankle to help ease some of the more jarring pain. But he warned me that the ease of pain would only be temporary, and that there was a 3 month recovery time on the procedure. I have, to date, opted out of every surgical option available to me.

I, presumably like many of you, have the arthritis of an 80 year old in my ankle. As well as arthritis that has creeped it's way into my knee. For a few years in my early twenties I took celebrex to try to dull some of the pain. But I found it didn't work all that well, and my doctor warned me of its numerous associated health risks such as kidney failure etc. So now I'm down to a Naproxen twice a day, and the occasional Tylenol. Hardly ever is that enough, but what else is there right?

I have good days and bad days with pain and inflammation flair ups. But lately, as I try to get back into motion, they seem like all bad days. It's incredibly disheartening and has led me to spending many sleepless nights wondering if I should be exploring other options or doing something differently. Maybe I should reconsider one of the surgical options? I don't know. I'm not really certain on anything at the moment. … anyways, that's my rant. Thanks for allowing me to get this off my chest.

Drew, 40, USA:

"I've been dealing with the pain for 15 years, trying to get by with orthotics, but enough was enough! I finally went under CN resection last Wednesday. I think I was unrealistic in my own assumption on recovery timeline, so it is helpful to read actual (TC) experiences."

Joni, 35, Australia:

"Sigh, that feeling when you need custom orthotics that may help with the pain and walking, but going private is $$$$ and you're not severe enough for public assistance and have been placed on a waiting list. I cant walk most days isn't that severe enough????"

Ellen, 28, USA:

"I am tired of pretending that everything is okay, cause it's not. I am, simply said functioning! I am in pain and continuing like I am not. Can I just scream it to the world?

This pain is killing me at times, I have very bad days and some not so bad. WHY? I am tired of fighting with doctors, I know how much it hurts and I am not making this up! I am overly exhausted and not to mention frustrated. I am at all costs trying to avoid taking meds due to a mass that I have in a kidney. Yes, I have all kind of crap. Just realized that everything is wrong with me!! So, if everything happens for a reason, please tell me what it is?

I am not looking for answers, I am just frustrated, that's all. I have anxiety, not to mention I have OCD, that stupid mass in my kidney and now this. All I know is that almost all doctors mention the word arthritis. One said I had a fracture and there was nothing he could do, really?
Perhaps we lose empathy in our journey to find answers."

Marion, 42, USA:
"I have had 4 foot surgeries, and still in pain, I had another MRI and it showed lots of inflammation. My doctor suggests a fusion. What to do?"

Kerryn, 40, Australia:

"I have been in pain since my teenage years. I've seen many dr and specialists until I turned 30 but it just ended up costing me a fortune for no resolution. At one point I was diagnosed with 'pseudo arthrosis'. I had many tests and was told that at best, I'd be in a wheelchair from a young age. I gave up, had 4 kids and stopped looking for answers. 

People didn't understand the pain I was in and I made a name for myself as a hypochondriac because I'd seen multiple people who mostly said there was nothing wrong or I had simply 'sprained' my ankle!

Not long after I turned 40, I requested an X-ray for my daughters knee and while talking to my dr I asked if I could have an X-ray of my feet that were also sore. I got an callback due to the arthritis forming in my left foot and was referred to an orthopaedic surgeon specialising in feet... he looked at the X-ray and instantly knew what it was. Tarsal coalition.

I was given the option of a resection surgery with an estimated success rate of around 40% but a fast recovery or a triple fusion with a 90% success rate but long, hard recovery. I have opted for the latter and have surgery next week."

Hannah, 21, USA:
I was 18 when they finally figured out I had tarsal coalition. It started when I was young though; about 7 or 8. I played softball growing up and all through high school. I always would have so much pain after practice or games and I would be in tears. I never knew why. 

Of course I got checked all the time but nothing was ever found. I put up with this pain for years. My siblings and family and friends all thought I was crazy. I wouldn't be able to walk some days or keep back the tears because of the pain. I did have several sprains but they never found the tarsal coalition. 

When I was 18 after my last softball season I decided I needed to go and for-real find out what was wrong. My foot had no range of motion besides up and down movements. There would be times I would get up and couldn't walk for a good 10 minutes. So I went to the best Ortho the state and he diagnosed me with Tarsal Coalition. He said he could put me in a boot and if that didn't help he could do a resection. Also, he told me losing weight would help too. 

What people don't understand is weather you are over weight or not the coalition will always be there. I feel like a lot of doctors use that excuse. 

The boot didn't help of course so I did the resection even though the Dr. seemed as if he didn't want to do it. The resection surgery was 6 weeks recovery, 4 weeks no weight bearing 2 weeks partial weight bearing. The restriction minimized my pain for almost two years. 

After I started working as a host, I soon was in severe pain every day. I would cry after every shift and use my crutches or crawl to bed cause I couldn't walk. It is like a stabbing pain in my foot. I feel like metal penetrates through my foot. It is the worst pain ever. 

So I went to a ankle specialist who did x-rays and quickly said I would need a ct and fusion surgery. So he gave me a cortisone injection and orthotics to see if that would give me any relief while I tried to get insurance. A few months later I got insurance and was able to get a Ct. He found that I had severe arthritis, now at the age of 21.... crazy. 

The specialist did a fusion surgery to fuse the subtalar and talonavicular joints in my foot. I am now 4 days out of surgery. He went in and cleaned the cartilage and joints then fused them. Come to find out I had no cartilage at all. I was bone to bone. This surgery is 3 months recovery. 6 weeks no weight bearing. 2 screws and a bracket. I just hope that it will work. 

I have put school off for a year now due to my chronic pain and this condition. It has taken over my life. I push through and stay strong but you can only go so far. Nobody besides the people with tc understand the pain or the way that it depresses you. I wish there was a way to heal it and take it away for good, but unfortunately it is not widely known and there hasn't been much research at all."

Morgan Elizabeth, 22, USA:


At age 10, I was diagnosed with both talocalcaneal and calcaneonavicular tarsal coalitions in both feet. I had two resection surgeries on each foot at ages 10 and 11. Long story short, I am 22 now and still deal with everyday pain and have accepted this as a chronic pain condition. However despite the struggle, I have been able to conquer so much in the past 12 years. 

I grew up dancing at a competitive level and went on to become a member of my dance academy's dance companies. I was a very active member in my high school's dance program and company and recently this past spring I graduated from college with a bachelor of science degree in Dance. Even though my dance days now have to be behind me, I am grateful for everything I was able to accomplish despite all the physical challenges I had to face living with the chronic pain of tarsal coalition. I would have days where I could not get out of bed to walk, could not participate in dance events, and questioned whether or not my passion for dance was worth it. I doubted my abilities, wished I could have "normal feet" and at times wanted to give up. 


I guess my advice for any child (and their parents) discovering they have Tarsal Coalition is to please do NOT let it the best of you and decide how you choose to live your life. I hope you will have the strength to continue to do whatever sport and/or activity makes you happy. Of course you should follow the orders of doctors and listen to your body but also know that this journey will make you stronger and more grateful for the days where you are pain free and able to participate in your sport.

Belem, 31, USA:

I've been in pain for as long as I can remember. I was always told it was because of flat foot. I used orthotics while I was a kid, which helped a little but not much with pain. At 18, I was diagnosed with TC, both feet. I was told by 3 different doctors that i have 50% chance to get better with surgery and 50% to get worse. With too many stories about people having unsuccessful  surgeries, and I can't afford surgery and recovery expenses, i've decided not to get any surgery yet, because at least I still can walk. Yes, with pain, but I can walk.

As other people with TC have said, there are many things I can't do like walk or run without pain, but I always try to keep moving. I will not let TC stop my life. It is hard to live with pain 24/7; some days worse than others, but i will postpone the surgery for as long as i can handle the pain.



Zach, 43, USA (Author):
Please see "Zach's TC Story" in blog entries on the right.

Saturday, October 29, 2016

What is a Tarsal Coalition?

Famously defined

"Tarsal Coalition". The name makes it sound like some kind of government committee; e.g. "Washington Asset Building Coalition" or the "Coalition for Multicultural Affairs", etc. But, anyone with even a layman's understanding of human anatomy will realize that "tarsal" refers to a specific part of the human body; the foot, to be exact. 


The definition of "tarsal" is "of or relating to the tarsus". Simple, right? Yeah, but what the heck is a tarsus? Well, that's easy enough. The tarsus is "a group of small bones between the main part of the hind limb and the metatarsus in terrestrial vertebrates. The seven bones of the human tarsus form the ankle and upper part of the foot. They are the talus, calcaneus, navicular, and cuboid and the three cuneiform bones."

Did you get all that? No, me neither. Basically, the tarsals are comprised of seven bones which makeup the ankle and upper portion of everyone's foot. See? You're learning something already! So, what could a "tarsal coalition" be? 


Well, a simple Google search of the phrase will bring up thousands of websites; all of which have simply copied and pasted the same definition, and that's exactly what I'm going to do next...

"A tarsal coalition is an abnormal congenital (birth defect) connection that develops between the 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."

Well, that sounds simple enough, eh? Yep, an easy search, and we have found out about a strange-sounding birth defect. In novice language, a tarsal coalition exists when some bones in the back of the foot and/or the ankle grow together. Weird, huh? 




What's it feel like? Well, if you're simply surfing the Internet for random knowledge, all those websites' explanations will suffice. And, according to those websites, even sites like mayoclinic.org or webmd.com, "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
  • Muscle 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"
Additionally, "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 11. Sometimes there are no symptoms during childhood. However, pain and symptoms may develop later in life."

Okay, so now we know a tarsal coalition is a painful foot condition in which some bones in the rear of the foot have grown together over time. And, we know that accompanying symptoms could include flat feet, a limp, stiffness and cramps ... as early as the moment the patient is born. 


Aside from the whole "birth" thing, that doesn't sound too bad, does it? 

Treatments that may help

For those who suffer from it, a tarsal coalition might really cramp their style. Can they get any relief? Of course, silly! It's easy as pie, according to those thousands of websites. Treatments include:

  • Nonsteroidal anti-inflammatory drugs may be helpful in reducing the pain and inflammation.
  • Physical therapy may include massage, range-of-motion exercises, and ultrasound therapy.
  • An injection of cortisone may temporarily reduce inflammation and pain. 
  • Custom orthotic devices may be beneficial in distributing weight away from the joint.
  • Sometimes the foot is immobilized to give the affected area a rest.
  • Injection of an anesthetic into the leg may be used to relax spasms.
  • If non-invasive measures prove unsuccessful in reducing discomfort and increasing mobility, surgery, consisting of either resectioning or fusing the afflicted joint may be an option.
Damn. All these treatments "may" be helpful, but there's no guarantee? What if they're not?

Well, lucky for us, there is no lack of knowledge about tarsal coalitions, is there? I mean ... the Internet is packed with information, so doctors must also know a lot about the condition, right? Wrong.

Is it common?

All of these websites refer to tarsal coalitions as somewhat "common"; suggesting that approximately 6% of the human population experiences at least one TC in one foot. However, according to the United States Library of Medicine, "far less than 1%" of the population has at least one tarsal coalition (Starmont, Peterson, 1983).

For the sake of discussion, let's say that .2% of the population has a tarsal coalition. Remember: That's two tenths of one percent of the entire population. This means that only 14 million people in the entire world have at least one tarsal coalition ... and only 600,000 TC patients exist in the U.S. That's right: More people live in Omaha, Nebraska than those who have one tarsal coalition. 



And, because of the rarity of TC's, most medical professionals simply have no idea how to treat them; let alone those who have heard of them. Sure, they may have heard something about TC's in medical school. But, chances are that, if they didn't study podiatry, they've never learned about them. Even many podiatrists (foot doctors) will never encounter a tarsal coalition in their medical careers.

Take me (the author) for an example. Since birth, I've had "bilateral subtalar tarsal coalitions". This means that since I was born, I've had TC's in the subtalar joint in both feet. The prevalence of my specific TC represents .001% of the population. This means that there are only 70,000 others like me in the entire world and only 3,000 like me in the entire U.S. (Bellapianta, Andrews, Ostrander, 2011).

 (Profile of author's left foot)

I have literally seen more than a dozen podiatrists in my life who have looked at my feet, shaken their heads and honestly told me, point blank, there was nothing they could do to help. One podiatrist even wrote me an excuse for an employer saying "Zach Jensen is walking on the medical equivalent of two broken ankles 24/7 and needs to be allowed to sit down when his pain is too great."

But, that doesn't mesh with all the information those countless other websites report, does it? How they made it sound was rather benign (non-threatening) ... maybe even only slightly inconvenient, right?

The bitter truth

What most doctors and even podiatrists won't tell their patients is that tarsal coalitions are more than an inconvenient occasional painful foot. Real symptoms of tarsal coalitions, taken from my experience and others include: 
  • Bone-on-bone pain whether standing or sitting;
  • Rigid muscles and tendons that never relax;
  • Heel bones that move over time like glaciers to the outsides of the feet; 
  • Easy stress fractures due to simply standing;
  • Sprains caused merely by attempting to pivot like "normal" people;
  • Full-leg muscle cramps caused by over-use of dysfunctional muscles and tendons;
  • Tendinitis 
  • Nerve damage;
  • Blood clots and poor circulation;
  • Atrophy in the calf muscles due to non-use;
  • Arthritis in ankles, knees and spine, because when the ankle doesn't work, it takes the entire body to stand up and walk;
  • Kidney failure caused by a lifetime of anti-inflammatory and pain medications;
  • Irritable Bowel Syndrome (IBS), sensitive stomachs and ulcers caused by medications, pain and stress;
  • Obesity due to the inability to exercise;
  • Severe depression caused by chronic, lifelong pain and loss of mobility;
  • Suicidal thoughts, because sometimes, no matter what, the pain never stops; 
  • Strained relationships, because literally almost nobody knows the pain and challenges we experience;
  • Chronic, unrelentless anger, because if we want to live, we are forced to continue living standing and walking on our broken feet;
  • And, only after all of this has been well-documented will we even be considered for our country's Disability option,
  • and even on Disability, it's extremely rare for Medicare (U.S.) to pay for a wheelchair so that we can get around without standing on our mangled and inflamed tarsals.

And, the primary reason for all of our continued suffering is that there is no dedicated medical classification billing code for "tarsal coalition", because it's so rare. So, due to the lack of TC knowledge in the medical community, combined with the lack of definition in the International Statistical Classification of Diseases and Related Health Problems (ICD), a medical classification list by the World Health Organization (WHO), patients with tarsal coalitions are often left to suffer excruciating pain with little or no relief ... all because no one has bothered to comprehensively represent tarsal coalitions to the health organizations upon which we rely for our care. 

 a page from the ICD

Only very recently, through the Internet, I have met others, who, like me, have begged their doctors to amputate their feet, because the pain is beyond imaginable. We have limped all our lives and jumped through all the hoops our doctors have recommended, and nothing has ended our pain. Because we are few, we are misunderstood by the medical community, ignored by our employers, stigmatized by our social circles and cast out like lepers in our schools and even in some families. 

On our best days, we can limp in extreme pain. On our worst days, we stay in bed, with numerous drugs and ice-packs, and if we need to, we are forced to crawl, like animals, to the toilet. 

This blog is intended to shed light, through real-lived experiences, by myself and others, on the condition known as "tarsal coalition"; for both personal and professional use. My hope is that the accounts described here will help the medical community better understand what it's like to live with this condition so that doctors and podiatrists will be better prepared to help us.

If a pet dog broke its leg, we would do anything to repair the leg or even amputate it so the animal doesn't suffer anymore. By forcing us to live with our broken feet, our medical communities are treating us worse than they treat their pets ...

... and we deserve better than that.


My left foot. Notice the heel bone on the outside. 

Bibliography
1. Bellapianta, Andrews, & Ostrander. (2011). Bilateral Os Subtibiale and Talocalcaneal Coalitions. Retrieved from https://www.scribd.com/document/243093176/Bellapianta-2011-Bilateral-Os-Subtibiale-and-Talocalcaneal-Coalitions-in-a-College-Soccer-Player-A-Case-Report

2. Stormont, DM, & Peterson, HA. (1983, December). The relative incidence of tarsal coalition. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/6641062