A tarsal coalition is an aberrant union between 2 or more tarsal bones and can be classified as osseous (synostosis) or nonosseous (cartilaginous [synchondrosis] or fibrous [syndesmosis]). This union may be complete or partial and the joints in the hindfoot and midfoot are most commonly affected. The resulting abnormal articulation presents as a noncorrectable flat foot, usually during adolescence, leading to accelerated degeneration within adjacent joints. An understanding of the condition and presenting symptoms enable the clinician to correctly diagnose and initiate appropriate treatment. This review discusses the evidence-based literature on the cause, diagnosis, and current management of tarsal coalition.