2025 年 133 巻 1 号 p. 33-37
This brief communication documents a case of tarsal coalition in a 15-year-old (± 30 months) adolescent from the Old Burial Ground in Heuvelton, New York. Macroscopic examination revealed pseudoarticulation, along with bilateral bony changes such as nodular bone, trabecular exposure, and porosity on the calcanei, naviculars, cuboids, and tali. These features were identified as bilateral non-osseous calcaneonavicular coalition. This case is significant as it is one of the few identified from a North American historical archaeological context, providing insight into the health conditions affecting a young settler in 19th-century rural upstate New York.
Tarsal coalition is the union of two or more tarsals of the hindfoot or midfoot, most often between the talus and calcaneus (TC coalition) or the calcaneus and navicular (CN coalition) (Crim and Kjeldsberg, 2004; Olney, 2010). As an error in segmentation, coalitions occur early during embryonic development, leading to a cartilaginous bridge between affected tarsals (Fopma and Macnicol, 2002). Rarely, such bridges can develop into fibrous or even osseous coalitions (Cooperman et al., 2001; Crim and Kjeldsberg, 2004). Tarsal coalitions are congenital, exhibiting partial to complete penetrative autosomal dominant inheritance (Klammer et al., 2018). Although they tend to occur in isolation, they have been associated with other hereditary conditions such as phocomelia, fibular hemimelia, carpal coalition, Nievergelt–Pearlman syndrome, and symphalangism (Olney, 2010; Klammer et al., 2018).
Tarsal coalitions vary in their presentation; non-osseous forms have cartilaginous or fibrous bridges between bones, whereas osseous varieties have a bony bridge linking bones that are normally separate (Case and Burnett, 2010). Although cartilaginous forms are generally asymptomatic, fibrous and osseous varieties can result in diffuse pain, tenderness, stiffness, and ankle instability, as well as painful conditions such as flatfoot (Crim and Kjeldsberg, 2004; Olney, 2010). Because of the asymptomatic nature of most tarsal coalitions, estimating their true clinical incidence is difficult; estimates range from 1% to 6%, while some cadaveric studies suggest rates as high as 13% (Klammer et al., 2018). Clinically, there is disagreement regarding whether tarsal coalitions vary based on sex, with some studies finding slight male predilection (e.g. Newman and Newberg, 2000) and others finding no such pattern (e.g. Rühli et al., 2003).
Tarsal coalitions were first described clinically by Buffon (1769) and almost 200 years later in the archaeological literature by Coe and Broman (1958). Although archaeological examples of tarsal coalition are relatively rare, isolated cases have been reported at sites in Europe (Calder and Calder, 1977; Mahieu, 1984; Silva, 2005, 2011; Dinwiddy, 2009; Hofmann et al., 2010; Silva and Silva, 2010; Varotto et al., 2021; Račanská et al., 2022), Asia (Burnett and Wilczak, 2012; Lieverse et al., 2012), Africa (Isidro et al., 2015; Boshoff and Steyn, 2000), and the Americas (Anderson, 1963; Heiple and Lovejoy, 1969; Han et al., 1986; Barnes, 1994). As noted by Case and Burnett (2010), tarsal coalitions are noteworthy because they are heritable, can be mistaken for trauma or joint disease in skeletal remains, and may lead to related pathological conditions. In this short report we describe a case of bilateral non-osseous CN coalition found in a 19th-century adolescent from a settler cemetery in rural upstate New York.
The remains of individual BF2 were recovered from the village of Heuvelton, NY at the site of the Old Burial Ground in the town of Oswegatchie (Figure 1). Before the establishment of a cemetery the dead were buried on family land or in local churchyards (Smithers, 1971). In 1868 the Heuvelton Cemetery Association was founded, and two years later the Old Burial Ground was closed. Per the 93rd New York State Legislature, family and friends were tasked with relocating graves to the newly created Hillcrest Cemetery (New York State Legislature, 1870). Not all the graves were relocated, however, and BF2 was among five complete individuals discovered during the construction of the Heuvelton Potable Water Upgrades project (Pitre et al., 2023). BF2 was interred in a white pine coffin and was wearing a small, probably brass ring on the fourth (ring) finger of their left hand. Unfortunately, there are no existing cemetery or archival records to provide an exact identification of BF2. Permission to analyze BF2 was granted by the New York State Historic Preservation Office (Abel et al., 2024).
(A) Map of New York state indicating location of Heuvelton (Marika Stauring). (B) Map of Heuvelton from 1865; the Old Burial Ground is marked with a black arrow (used with permission of the Heuvelton Historical Association).
The skeletal remains of BF2 were inventoried and examined for preservation and completeness following Buikstra and Ubelaker (1994). Age was estimated using epiphyseal fusion and dental and bone development (Buikstra and Ubelaker, 1994; Schaefer et al., 2009). Because the individual is a non-adult, no attempt was made to estimate sex. Stature was estimated from the right humerus, radius, ulna, and fibula, using criteria outlined by Trotter (1970). All available tarsals were examined for evidence of coalition. Per the New York State Historic Preservation Office, only non-destructive techniques were permitted and no X-ray or microcomputed tomography were available due to the COVID-19 pandemic and the short reburial window.
Following Albee (2020), CN coalition was identified by: (1) a plantar navicular beak, (2) an abnormal articulation between the calcaneus and navicular, (3) anterior or medial extension of the calcaneus, (4) absence of the anterior talar facet, and (5) a facet for the cuboid on the navicular. The type of CN coalition was recorded according to Cooperman et al. (2001): Mild Type 1, where the anterior talar facet articulates normally with the anterior calcaneal facet; Moderate Type 2, where the anterior talar facet articulates with the calcaneonavicular junction due to the replacement of the anterior calcaneal facet by the navicular; and Severe Type 3, where the anterior talar facet articulates completely with the navicular rather than the anterior calcaneal facet.
Individual BF2 is a 15-year-old (± 30 months) adolescent of unknown sex whose stature is estimated to be 150.9 ± 3.9 cm. All tarsals of this individual were recovered, and overall preservation is excellent (75% complete).
The calcanei, naviculars, and cuboids exhibit altered morphology and associated pseudoarticulation (Figure 2). Both calcanei lack anterior talar facets; in their place there is nodular bone with cystic lesions (Figure 3). The naviculars are broadened mediolaterally (as are the facets), forming a navicular beak with a characteristic linear plantar edge that has matching cystic lesions for the calcanei and facets for the cuboids (smaller on right). Similarly, both cuboids display small articular surfaces on the medioposterior region for the naviculars (also smaller on right) (Figure 4). Both tali have normal morphology.
Plantar view of left calcaneus and navicular articulation. The articulation between the navicular and calcaneus is indicated with the black circle.
(A) Superior view of left and right calcanei showing bilateral lack of anterior talar facets. (B) Anterior view of left calcaneus showing lack of anterior talar facet and presence of porosity.
(A) Right navicular with ‘beak’ and facet for cuboid indicated with black arrows, and right cuboid with articular surface on medioposterior region developed for navicular indicated with black arrows. The navicular ‘beak’ has reactive bone present. (B) Posterior view of right navicular showing porosity on the navicular tubercle.
In addition, the calcanei, naviculars, cuboids, and tali present porosity and reactive bone. On the calcanei the porosity is diffuse, located on most non-articular surfaces. The naviculars present a small area of reactive bone on the tubercles (Figure 4B) and on the dorsal and distal articular surfaces. On the cuboids there is porosity proximal to the cuboid tuberosity on the plantar surface. The tali exhibit porosity and reactive bone on several non-articular surfaces (e.g. superior to the subtalar articular surface of the talar head, anterior to the trochlear articulation). Finally, the fifth interproximal and distal pedal phalanges of the left foot are fused.
The skeleton of BF2 exhibits pseudoarticulation between the calcanei, naviculars, and cuboids in both feet in addition to porosity, reactive bone, and fusion of the intermediate and distal phalanges of the fifth left toe. Such a presentation can be congenital but may be secondary to trauma, infection, or degeneration (Fopma and Macnicol, 2002; Olney, 2010; Klammer et al., 2018; Albee, 2020). Trauma and infection are ruled out because there are no signs of fracture (indicating trauma) and associated bone remodeling, coupled with the fact that the coalition is bilateral. Degenerative joint disease and degenerative arthritis were excluded because of the individual’s age and the absence of osteophytes, microporosity, or eburnation, suggesting that the most likely diagnosis is tarsal coalition with associated symphalangism of the fifth toe, both developmental issues of congenital origin.
The presence of a navicular beak, the abnormal connection between the calcaneus and navicular, mediolateral extension of the calcaneus, absence of the anterior talar facet, and a facet for the cuboid on the navicular indicate a Moderate Type 2 CN variety as outlined by Albee (2020) and Cooperman et al. (2001). Despite the literature suggesting challenges in assessing non-osseous coalitions as cartilaginous or fibrous, the symmetric lytic lesions and exposed trabeculae on the naviculars and calcanei, along with pitting in the articular regions, suggest a cartilaginous connection (Case and Burnett, 2010; Albee, 2020). Although there is no evidence of related conditions such as phocomelia (all limb long bones are present), fibular hemimelia (both fibulae are present), carpal coalition (lack of fused carpals), or Nievergelt–Pearlman syndrome (no deformities of the forearm and shin are present) (Olney, 2010; Klammer et al., 2018), symphalangism is sometimes associated with tarsal coalition (Fopma and Macnicol, 2002).
Although an estimated 76% of tarsal coalitions are completely asymptomatic, they can become symptomatic over time as ossification causes increased foot stiffness (Klammer et al., 2018). For CN varieties, this usually occurs between 8 and 12 years of age (Klammer et al., 2018). Although symptoms can vary due to genetic factors and minor anatomical differences, it is likely that BF2 experienced some discomfort, evidenced by the noted porosity and reactive bone which suggest inflammation. A lack of intervention could have led to continuous microfracturing and remodeling of the cartilaginous bridge, which, had this individual survived, might have led to the early development of osteoarthritis or flatfoot (Case and Burnett, 2010; Albee, 2020).
Few historical archaeological cases of tarsal coalition have been recorded in North America. Case and Burnett (2010) report on a handful of US cases such as the discovery of osseous and non-osseous talocalcaneal coalitions dated to 1000 AD in Blain Mound, Ohio (Heiple and Lovejoy, 1969); a case of osseous talocalcaneal coalition in Kona, Hawaii (Han et al., 1986); an example of osseous naviculocuneiform 1 dated between 850 and 1150 AD in Pueblo Bonito, New Mexico (Barnes, 1994); and an osseous cuneiform II–III dated to 1400 AD in Fairty Ossuary, Ontario (Anderson, 1963). The scarcity of recent historical cases (especially non-osseous varieties) reported in the palaeopathological literature underscores the importance of documenting this case from the Old Burial Ground in Heuvelton, NY. Such a discovery provides valuable insight into the occurrence and experience of tarsal coalitions through time and space.
In this paper we present a case of bilateral non-osseous CN coalition in a 19th-century adolescent from the Old Burial Ground in Heuvelton, NY. The individual presents with bilateral pseudoarticulation between the calcanei, naviculars, and cuboids in addition to porosity and reactive bone also involving the tali, and symphalangism of the intermediate and distal phalanges of the fifth left toe. This individual probably experienced discomfort while walking. Although the skeletal remains of BF2 were left behind in the Old Burial Ground, their discovery and analysis offer a glimpse of what life and death were like for settlers in 19th-century rural New York and add to the bioarchaeological literature concerning tarsal coalition in North America.
The authors thank the Village of Heuvelton and the State Historic Preservation Office of New York for the opportunity and privilege to work with and study the individuals from the Old Burial Ground in Heuvelton, NY.
The excavation of the Old Burial Ground was funded by the United States Department of Agriculture (USDA) Rural Development and the Village of Heuvelton, NY. Funding for the skeletal analysis was provided by St. Lawrence University, Canton, NY.
The authors declare no conflict of interest.
Marika Stauring: methodology, investigation, writing original draft, and editing; Madeleine Mant: conceptualization, methodology, investigation, writing original draft and editing, data curation, visualization, and supervision; Mindy Pitre: conceptualization, methodology, investigation, writing original draft and editing, data curation, visualization, and supervision; Kayla Mander: methodology, writing original draft and editing; Timothy Abel: writing original draft and editing and supervision; Linda Johnson Wood: writing original draft and editing
