32 feet in 27 adults, seen at The Johns Hopkins Hospital Foot and Ankle Clinic from 1993-1998, with the diagnosis of tarsal coalition were retrospectively reviewed. There were 18 subtalar coalitions, 14 calcaneonavicular coalitions and 1 naviculocuneiform coalition. The average age was 40 years. Clinically, 22 feet had a neutral heel, 7 had a valgus heel with flattening of the longitudinal arch, 1 had a varus heel and 2 heels had an unknown position. Subtalar motion was decreased in 23 feet. Peroneal spasm was only seen in 2 patients. 11 feet were asymptomatic. Nonoperative treatment consisting of activity modification, nonsteroidal anti-inflammatory medications and casting was successful in the majority of patients. Subtalar fusion was performed in 4 feet and coalition resection in 1. The treatment of a symptomatic tarsal coalition in the adult is as in children but the clinical presentation may differ.