Arthroscopy of the Subtalar Joint


Indications

  • Posterior subtalar impingement syndrome due to symptomatic os trigonum

  • Flexor hallucis longus tenosynovitis

  • Arthrofibrosis

  • Subtalar arthrosis

  • Calcaneal/talar fracture reduction control

  • Osteochondral lesions

Indications Pitfalls

  • Active infections

  • Severe subtalar malalignment

Indications Controversies

  • Talocalcaneal coalitions

  • Triple arthrodesis

Examination/Imaging

  • Range of motion of the subtalar joint must be addressed and compared with the opposite side, and pain must be evaluated either on physical examination or after anesthetic injection ( Fig. 42.1 ).

    FIG. 42.1

  • Anteroposterior, lateral, and oblique (Brodén) views of the ankle should help to evaluate subtalar architecture ( Fig. 42.2 ).

    FIG. 42.2

  • Computed tomography scan must be ordered with axial and semicoronal cuts to evaluate all three subtalar facets ( Fig. 42.3 ).

    FIG. 42.3

  • Magnetic resonance imaging can rule out soft-tissue pathology and better evaluate intraosseous subchondral compromise.

Treatment Options

  • Open procedures

  • Steroid shots in case of noninfectious disease

Surgical Anatomy

  • Three facets of the subtalar joint: posterior, medial, and anterior ( Fig. 42.4A [talar side], Fig. 42.4B [calcaneal side])

    FIG. 42.4

  • Oblique and curved fashion of the subtalar joint ( Fig. 42.4C )

  • Peroneal tendons, flexor hallucis longus tendon, and interosseous ligament ( Fig. 42.5 )

    FIG. 42.5

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