Subtalar Joint Arthritis or Pathology

The Subtalar joint is between the talus and the calcaneus bones in the hind foot, underneath the ankle joint. It helps with side to side motion of the hind foot especially when walking on uneven ground, such as sand and particularly when walking bare footed. It also helps to dissipate forces associated when the heel strikes the ground. If arthritis is present, there will be damage or degenerative changes to the joint cartilage which can become thin and eventually allow bone on bone contact. This can cause pain, swelling and stiffness of the affected joint. Therefore it is most noticeable when walking or running. Generally symptoms wax and wane but eventually worsen over time. There are a variety of nonsurgical and surgical options available to help you return to a more normal, active lifestyle.

  • Video:

    This surgical procedure is used to help relieve pain in the joint beneath the ankle joint and correct deformities in the hindfoot caused by injury, arthritis, or genetic defect. The procedure fuses the calcaneus (the heel bone) to the talus, the bone that connects the foot to the ankle.

  • Cause:

    In the subtalar joint it can be due to:

    • Primary osteoarthritis with articular cartilage damage
    • Secondary osteoarthritis: related to trauma or previous fractures, or increased joint stress from
      adjacent joint disease
    • Inflammatory arthropathy most commonly rheumatoid arthritis

    Other problems which may necessitate surgery to the subtalar joint are:

    • Instability or deformity of the hind foot e.g. Posterior tibialis tendon dysfunction
    • Talocalcaneal coalition – an abnormal fusion between the talus and the calcaneus bones
  • Symptoms:

    May depend on the specific underlying cause. Usually involve pain especially with activity and particularly first thing in the morning, progressive stiffness and difficulty walking on uneven ground.

    Possibly swelling/clicking/catching.

  • Natural History:

    Usually gradually gets worse over time. Symptoms may wax and wane.

  • Imaging:

    Weight bearing X-rays are required with additional views.
    At times: long leg X-rays, CT scans or MRI scans are required.

  • Non Operative Treatment:
    • Topical pain creams e.g. NSAIDS
    • Pain medications eg NSAIDS such as Mobic; Panadol Osteo
    • Lace up ankle brace, AFO brace (AnkleFootOrthosis)
    • UCBL orthosis
    • Shoe wear modification: lace up ankle boots, stiffer soled shoe with rocker bottom modification
    • Activity modification: Improve fitness and strength via non axial loading exercises e.g. cycling,
      swimming. Avoid axial loading exercises e.g. running
    • Weight loss management
    • Joint injections
  • Surgery:
    Considered if symptoms are progressing and function is decreasing after a trial on non surgical treatment. Sometimes these procedures may be combined with other procedures.
    Depending on the extent and nature of disease, surgical options may include:

    • Arthroscopic procedures
    • Arthroscopic fusion
    • Open fusion

Post Operative Guide

General info: