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This study compares activity levels of patients with tarsal coalitions who did and did not have surgery and quantifies the return-to-activity time after tarsal coalition surgery. Thirty-one patients (mean ± SD age, 22.1 ± 11.6 years) with 39 coalitions (28 talocalcaneal, 1 complete talonavicular, and 10 calcaneonavicular) were included. The mean postoperative review time was 3 years. Fifteen patients (17 feet) who underwent resection had a mean ± SD return-to-activity time of 10.3 ± 5.8 weeks. There was no statistically significant difference in the return-to-activity time between talocalcaneal and calcaneonavicular coalitions. Thirteen patients (21 feet) quit sports; 11 (17 feet) were from the nonsurgical group. Three nonsurgical patients continued playing sports. The Fisher exact test was used to determine whether those forgoing surgery had a decreased ability to achieve desired activity levels. The correlation of surgery and failure to achieve the desired activity level was low (–0.69). Therefore, tarsal coalition excision is not correlated with failure of patients to reach desired activity levels. Patients forgoing surgery could not reach desired activity levels. Surgical excision of tarsal coalitions has a favorable outcome. (J Am Podiatr Med Assoc 93(4): 259-263, 2003)