Subtalar Arthrodesis – Surgical Fusion of the Subtalar Joint
Subtalar arthrodesis is a surgical procedure to fuse the subtalar joint, relieving pain and stabilising the hindfoot in cases of severe joint disease or deformity.
Things worth knowing about "Subtalar Arthrodesis"
Subtalar arthrodesis is a surgical procedure to fuse the subtalar joint, relieving pain and stabilising the hindfoot in cases of severe joint disease or deformity.
What is Subtalar Arthrodesis?
Subtalar arthrodesis is a surgical procedure in which the subtalar joint – also known as the talocalcaneal joint – is permanently fused. This joint is located between the heel bone (calcaneus) and the ankle bone (talus) and is responsible for the inversion and eversion movements of the foot. By fusing these two bones together, all motion at this joint is eliminated. The primary goals of the procedure are long-term pain relief and the restoration of a stable, functional foot alignment.
Indications – When is Subtalar Arthrodesis Performed?
Subtalar arthrodesis is recommended when conservative treatments have failed to provide adequate relief. Common indications include:
- Post-traumatic osteoarthritis following calcaneal fractures or talar injuries
- Primary osteoarthritis (degenerative joint disease) of the subtalar joint
- Rheumatoid arthritis affecting the subtalar joint
- Avascular necrosis of the talus (death of bone tissue due to impaired blood supply)
- Severe hindfoot deformities such as flatfoot or clubfoot
- Joint instability resulting from ligament injuries or neurological conditions
- Failed previous surgical procedures on the subtalar joint
Surgical Technique
Subtalar arthrodesis can be performed using different surgical approaches. The choice of technique depends on the severity of the condition, bone quality, and the individual anatomy of the patient.
Open Arthrodesis
In the open technique, the joint is accessed through a lateral incision at the hindfoot. The remaining articular cartilage is completely removed to allow direct bone-to-bone contact. The foot is then positioned in the desired alignment and fixed using screws, staples, or plates. If necessary, bone grafts (autologous or allogeneic) may be used to support bone healing and promote fusion.
Arthroscopic (Minimally Invasive) Arthrodesis
In suitable cases, the procedure can be performed arthroscopically through small incisions using a camera and specialised instruments. This approach causes less trauma to the surrounding soft tissues and is generally associated with shorter recovery times and a lower risk of infection.
Postoperative Care and Rehabilitation
Consistent postoperative management is essential for the success of the procedure.
- Immobilisation: The foot is placed in a cast or orthopaedic boot for several weeks following surgery.
- Weight-bearing restrictions: Full or partial weight-bearing is typically restricted for 6 to 12 weeks after the operation.
- Physiotherapy: Once weight-bearing is permitted, physiotherapy begins to strengthen the surrounding musculature and improve gait.
- Bone healing: Complete osseous fusion may take between 3 and 6 months and is monitored through regular X-ray examinations.
Risks and Possible Complications
As with any surgical procedure, subtalar arthrodesis carries certain risks:
- Non-union (pseudarthrosis): Failure of the bones to fuse completely
- Wound or bone infection
- Nerve injury causing numbness or altered sensation around the foot
- Deep vein thrombosis (blood clots in the leg veins)
- Implant failure or loosening of screws or plates
- Persistent pain or incomplete pain relief
- Increased stress on adjacent joints, potentially leading to secondary arthritis
Outcomes and Prognosis
Subtalar arthrodesis is considered an effective procedure for long-term pain relief and improvement of quality of life. Reported fusion rates in the literature range from approximately 85 to 95 percent. Most patients are able to walk pain-free following complete recovery. Since subtalar motion is eliminated after fusion, inversion and eversion of the foot are partially compensated by adjacent joints. Low-impact physical activities such as cycling and swimming are generally possible after full healing has occurred.
References
- Easley M.E., Trnka H.J., Schon L.C., Myerson M.S. (2000): Isolated subtalar arthrodesis. Journal of Bone and Joint Surgery (American Volume), 82(5): 613–624.
- Herscovici D. Jr., Sammarco G.J. (2001): Subtalar arthrodesis – a review of the literature. Foot and Ankle Clinics, 6(1): 173–183.
- Mann R.A., Baumgarten M. (1988): Subtalar fusion for isolated subtalar disorders. Clinical Orthopaedics and Related Research, 226: 260–265.
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