Histopathological analysis was performed on 55 feet in 48 patients with nonosseous tarsal coalitions. Histological findings were similar to those observed at the tendinous attachment site of Osgood-Schlatter disease, accessory navicular, and biparite patellae. No nerve elements were observed in the fibrocartilaginous tissue at the coalition. Nerve elements were present only in periosteum and articular capsule surrounding the coalition pain in the tarsal coalition is not mediated by nerve elements at the coalition site itself. It is assumed that the pain is caused by mechanical abnormality that results from incomplete coalition. Incomplete coalition produces microfractures and remodelings on the boundaries between bone and the coalition, which then lead to degenerative changes. This mechanical abnormality seems to induce pain via free nerve endings in the periosteum and in the articular capsule surrounding the coalition.
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