Tarsal coalitions are recognized as a congenital anomaly whereby the two or more bones of the hindfoot and midfoot are fused resulting in limitation of foot motion and pain. Tarsal coalitions were found to be the cause of painful flatfeet in adolescents and young adults. Developing a clinical understanding of tarsal coalitions as well as developing a step-wise conservative and surgical approach for their treatment can alleviate patient symptomatology and provide excellent long-term benefits. Conservative treatment consists of immobilization, NSAIDs, and casting for symptomatic patients, and surgical treatment for symptomatic tarsal coalition consists of resection and/or arthrodesis.