Among the non-surgical treatment options for subtalar arthritis are weight loss programmes, which help to reduce the amount of weight which is placed on the hindfoot, decreasing the forces which go through it; modifying activities to reduce the amount of walking and standing which is done, especially on uneven surfaces; ankle bracing, often using an ankle brace, which can limit the forces going through the joint; more comfortable shoes, which can offer more shock absorption in the heel area; and the ice and elevation routine, which ices the ankle and hindfoot region, and elevates the leg in order to reduce both swelling and pain 👍
Patients with subtalar arthritis will complain of pain on one or both sides of the foot, just below the ankle bones (malleoli). This is commonly illustrated by the patient encircling the affected foot with their fingers, just below the level of the bony prominence on either side of the ankle (malleoli). The hollow just in front of the outside ankle bone (the sinus tarsi) is another common location of pain. The sinus tarsi is a space surrounded by the three contact areas between the talus and calcaneus, that comprise the subtalar joint. The subtalar joint is largely responsible for allowing the foot to accommodate uneven terrain by moving the hindfoot from side to side (inversion and eversion). Walking on uneven surfaces places a great deal of stress on the subtalar joint and may be difficult, if not impossible, to accomplish in patients with subtalar arthritis.
Chase Ferreira at jrheum.org, mentions how anatomically, the talus forms the mechanical gateway from the leg to the foot4. Its superior surface articulates with the fibula and tibia. A complex articulation is formed between the talus, calcaneus, and navicular bone inferiorly and anteriorly4,5. The subtalar joint is functionally a single joint that, anatomically, is divided into an anterior part, the talocalcaneonavicular joint or anterior subtalar joint (ASTJ) and a posterior part, the talocalcaneal joint or posterior subtalar joint (PSTJ)4,5. The ASTJ is formed by the navicular bone and the head of the talus anteriorly and the anterior and middle facets of the talus and the calcaneus (sustentaculum tali) inferiorly (Figure 1a and 1b). The spring ligament supports the joint inferiorly. The talonavicular joint and anterior talocalcaneal joint therefore form a continuity and together will be referred to as the ASTJ4,5. The ASTJ is separated from the PSTJ by the sinus tarsi and tarsal canal with several strong ligaments within the sinus tarsi. The PSTJ consists of the posterior facets of the talus and the calcaneus4,5. It is difficult to assess clinically but the various components can well be assessed sonographically. Several approaches have been suggested. In a recent publication focused on the anatomic and sonographic description of the subtalar joint in adults, a set of 4 scans for the subtalar joint has been proposed5. The posterior subtalar joint has a separate joint capsule that usually does not communicate with the anterior articulation6. Both joints have a common dependent axis of motion akin to the hinges on a door4. The medial and lateral ankle tendon compartments are in close proximity to the subtalar joint. The synovial sheaths of the flexor hallucis tendon may communicate with the tibiotalar or subtalar joint. In patients with RA, the subtalar joint may also communicate with the tibiotalar joint6,7. It is noteworthy that symptoms may arise from these tendon structures as well as the tibiotalar and subtalar joint.
Brittnay Sinclair from countryfootcare.com, explains how this condition is usually the result of a traumatic injury, with the most common cause being an ankle or heel fracture in the subtalar joint. If the ankle doesn’t recover well, the bones may grind against each other and cause pain. Further problems could result from someone overloading the ankle to compensate for a misalignment of the bones or a condition like tarsal coalition. Chronic ankle instability and pre-existing ankle arthritis also strain that lower joint, causing wear and damage. This needs to be addressed before the foot’s injury progresses too far for you to ever regain full range of motion.