Subtalar Joint Pain

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SUBTALAR JOINT AND “SINUS TARSI SYNDROME”
By: Robert H. Sheinberg, D.P.M., D.A.B.F.A.S., F.A.C.F.A.S.

What and where is it?

The joint below the ankle that connects the talus to the calcaneus. There are ligaments, nerves, fat and synovial lining that are susceptible to stress and injury.

What does the joint do?

The subtalar joint allows your foot to turn side-to-side and adapt to uneven surfaces. It is an important shock absorbing joint that helps prevent injuries and fractures to the leg and spine.

How do injuries occur?

  • Twisting injuries that occur on uneven surfaces or during sports and activities.
  • Motor vehicle accidents where the heel stays solid on the floorboard and the foot shifts over it. 
  • Running on uneven surfaces such as the beach or gravel when you are not accustomed to that.
  • Slide tackles in soccer in which the foot is pointed down to an extreme.
  • Falls from a height directly on your heel may cause fractures into the joint.

Signs and symptoms:

  • Swelling may be present on the back or outside of the foot and the lower portion of the ankle.
  • Possible loss of side-to-side motion.
  • Pain and stiffness getting out of bed in the morning to walk. This may improve with weight bearing and then cause pain or a deep ache later on in the day.
  • Inability to turn the foot side-to-side with comfort during a golf swing or tennis motion.
  • Feeling of instability on uneven surfaces.

How are injuries diagnosed?

  • A thorough history and physical examination of the lower extremity and foot.
  • X-rays are taken to rule out fractures, tumors, osteoarthritis or joint misalignment.
  • The possible ordering of MRIs to evaluate the ligaments, tendons, joint, bone marrow and surrounding soft tissue structures.
  • Possible CT scans for a better evaluation of the bony structures.

Treatment:

  • Conservative care for most injuries may include oral anti-inflammatories or Cortisone injections to reduce inflammation.
  • Physical therapy to help strengthen surrounding muscles, improve joint range of motion and general lower extremity flexibility and balance.
  • Orthotics made to go in your shoes to support the injured area, especially if the foot is very high or low arches. 
  • Arthroscopic surgery may be needed to clean out damaged tissue if conservative treatment fails. A 1/6” camera is placed in the side or back of the foot and small instruments are used to clean up the joint damage. If there is no arthritis, an excellent outcome is expected. If more damage is seen to the cartilage surface, bone cuts or joint fusions may be necessary. Still, the prognosis would be excellent.

Prognosis is always going to be greatly improved if the condition is evaluated quickly and treated early.

Intraoperative subtalar joint arthroscopy pics


Scarring in the subtalar joint


Scar tissue at the middle facet


Cleaned out middle facet


Scar tissue and fibrous band in the subtalar joint


Cleaning out the joint


Scar tissue around the Posterior facet

 

Cleaned out posterior facet

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