Tarsal coalition has been recognized as a pedal anomaly for hundreds of years. Consistent research through the years has led to new advances in the understanding of this problem. New ideas concerning etiology, incidence, diagnosis, and treatment have necessitated a review of the most recent literature concerning tarsal coalition and its associated disorders. The authors present an update on the current therapies, diagnostic modalities, and corrective procedures involved. This article combines the most current imaging techniques with those traditionally accepted. The authors suggest magnetic resonance imaging (MRI) to replace computerized tomography (CT) scan as the diagnostic imaging technique of choice. An analysis of all the surgical procedures is discussed, and suggestions are made as to the most appropriate approach to this insidious and disabling pathology.