ESCANABA — Being a parent is challenging these days, with our offspring exposed to all manner of dangerous germs and internet dangers. Our children’s health is understandably important and when they have problems, most parents want to resolve the issue. But what if it’s a mystery? The sudden development of a painful foot can lead a parent to desperation. Why would a 10 year old suddenly be unable to run without pain?

This is exemplified by the story of William, an active and energetic young man who loved to run and play, enjoying sports of all sorts. You know the type; he was generally the last to return home after a day of play. When William came home early one summer day complaining of significant sharp pain from his foot, concerns were raised. Although his symptoms resolved overnight, the pain recurred the next time he was active. And they returned each time he played thereafter. For a ten year old, this was unacceptable.

A very different scenario occurred with Dan, an inactive 40 year old, who worked as an accountant. He had never enjoyed sports and hated running but had experienced no significant pain from his feet until a year ago. Ever since a dull, aching pain began emanating from the ankle region. His activity levels became even further reduced because of the discomfort. He had more pain with activity, with even a short trip to the grocery store resulting in a disconcerting ache.

In neither of these individuals was trauma a part of the history. In both the truth was far stranger than a mere sprain. Each of them suffered different symptoms and at different stages of life. But both possessed a moderately uncommon condition known as a tarsal coalition, an abnormal union between two bones of the feet.

This condition, resulting in a problematic stiffness, is due to a failure of differentiation during development. Two bones that should ultimately be separate and distinct don’t become so, retaining an inappropriate connection. This is the essence of a coalition: an abnormal union.

With any appreciation of the importance of foot and leg biomechanics, one may glimpse the potential for complications from a solid connection when there should be none. The complex mechanics of the lower extremity, which provide for normal ankle, knee, and low back function, will be inhibited.

Without a high index of suspicion, it is frequently missed on regular x-rays, and the individual’s pain goes undiagnosed and untreated. Visualization of this bony bridge can be difficult, requiring a particular x-ray. And since the connection is often not bony but cartilaginous, x-rays may show nothing. This explains the experience of Dan, our second protagonist, who developed foot pain as a middle aged adult but had never had it previously identified.

Symptoms do vary person to person, as can the time of onset (i.e. when the pain becomes noticeable). Naturally, the treatment also differs and depends on multiple factors. Many live with this deformity and have no treatment whatsoever, but chances are good at some point they suffered from some musculoskeletal condition, which was the result of altered gait biomechanics.

The well-known R.I.C.E. formula (rest/ice/compression/elevation) is temporarily helpful for acute inflammation and these feet can become so with a day of increased activity. Similarly, corticosteroids, via the common cortisone injection, have a long history of use for a painful joint. Unfortunately for millions, when the cause of the inflammatory pain is still present (like a degenerated knee joint), this approach provides only temporary relief.

Altering (correctly) foot motion, as well as physical stress, to the many joints and structures of the foot can provide relief. If this can be done effectively, we can reduce the stress and thus the amount of inflammation produced. Physical but excessive manipulation of the myriad components of the foot and lower leg can be minimized.

Innumerable generic arch supports are available which vary greatly in their materials, their design, and of course their benefits. But the right support for the right person can markedly reduce the stressors that accompany standing and walking. Unfortunately, these are all obviously generic, and in no way customized or specialized.

A prescription device can provide tremendous symptomatic relief while also serving to reduce stress to neighboring body parts, various and sundry articles like knees and spines. If made with a detailed examination, including an evaluation of gait and stance, these can provide unexpected relief. Unfortunately, just because a mold is made of the feet in no way equates to an effective foot orthosis.

Surgery is an option and can be the best option for the right person at the right time, typically a younger person who hasn’t experienced the joint degradation of one who has lived with this situation for years. By removing the bony bridge, normal motion is frequently obtained. Normal function, proper motion of all these many joints, means no limitations and no symptoms.

Many of us have an undiagnosed coalition in the foot. It is commonly unrecognized but may produce more significant symptoms only in our later years. Too many Americans live with chronic pain that isn’t debilitating but subtracts from their quality of life. It is possible the solution isn’t difficult.

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Dr. Conway McLean is a physician practicing foot and ankle medicine in the Upper Peninsula, with offices in Escanaba, Marquette, and L’Anse. McLean has lectured internationally on wound care and surgery, being board certified in surgery, orthotic therapy and wound care. His articles on health and wellness appear in multiple local and national publications. Dr. McLean welcomes subject requests for future articles at drcmclean@outlook.com.