Introduction:
Subtalar osteoarthritis (STOA), which negatively impacts patients' quality of life, is frequently brought on by recurrent ankle sprains or trauma. Posttraumatic ankle osteoarthritis can occur in as many as 78 percent of those with persistent ankle instability. The connection between the talus and the calcaneus is referred to as the subtalar joint. It is a complex joint used in human movement and is crucial for propulsion and shock absorption. This joint is made to either give a flexible shock-absorbing structure or a hard propulsive structure to the foot.
What Are the Causes of Subtalar Arthritis?
The joint between the foot and the ankle is impacted by subtalar arthritis. It occurs as a result of the joint experiencing overuse injuries or severe wear and tear. Chronic lateral ankle discomfort frequently has an underlying etiology that is unclear. However, it may be brought on by an accident or even a pair of shoes. The common conditions or diseases that can cause subtalar arthritis are:
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Gout (a form of arthritis).
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Rheumatoid or inflammatory disease.
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Primary osteoarthritis.
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Talocalceneal coalition (an abnormal connection between bones in the feet).
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Tibialis posterior tendon dysfunction (a disease of the foot and ankle).
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Septic arthritis.
What Are the Symptoms of Subtalar Arthritis?
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The subtalar joint has a wide range of motion, which makes it vulnerable to damage. The feet are continually going up and down when people walk. The feet's joints are subjected to a great deal of strain as a result, which over time may result in arthritis. Patients can feel pain when walking or getting up from a chair if they have arthritis in the subtalar joint.
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A person who has subtalar joint arthritis and an unbalanced arch of the foot may benefit from arch support to align the heel and forefoot properly. Restricting aberrant mobility might ease pain, as can reinforcements for the feet, ankles, and insoles.
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The bones of the ankle may rub against one another and produce pain if it does not heal properly. Just below the ankles, on one or both sides of the foot, patients with subtalar arthritis report pain.
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In most cases, pain is felt immediately below the level of the ankle's inner and outer bones. Patients with subtalar arthritis frequently demonstrate this by encircling the foot that is affected and having their toes slightly below the level of the bony prominences on either side of the ankle.
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On the outside or the back of the foot, there could be discomfort and swelling as well. Patients can frequently be considerably more active even though their foot loses lateral motion since they are in a lot less discomfort.
What Are the Investigations to Be Done in Subtalar Arthritis?
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X-rays will show a reduction in the subtalar joint space, which is best seen on a lateral view of the foot taken when the patient is bearing weight.
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To establish the degree of subtalar arthritis and to rule out any other sources of pain (such as ankle arthritis, posterior tibial tendonitis, peroneal tendonitis, etc.), a CT (computed tomography) scan or MRI (magnetic resonance imaging) may be recommended.
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A diagnostic injection of a local anesthetic, such as Lidocaine, may occasionally be used to try to determine how much pain is coming from the subtalar joint. The injection may occasionally be administered with the help of an ultrasound, fluoroscopy (a miniature x-ray), or CT scan to guarantee that the anesthetic agent is placed precisely. When the lidocaine wears off after a few hours, the discomfort could even get worse for a short while. However, if the patient experiences significant pain alleviation for several hours following the injection, it is likely that the subtalar joint, the location that was injected, is the source of the majority of the symptoms.
How Is Subtalar Arthritis Treated?
1. Non-operative Treatment: The goal of non-operative treatment is to reduce loading and mobility at the subtalar joint while also numbing the discomfort. The patient must experiment with different non-operative treatment options to determine which ones work best for them. Non-operative therapies consist of:
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Activity Modification: Restricting standing and walking, especially on uneven surfaces, will help prevent subtalar arthritis symptoms from getting worse. Instead of walking or jogging, it will probably be advantageous to use an exercise bike or go swimming as a type of cardiovascular training because it allows for a terrific workout with much less strain through the subtalar joint.
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Weight-Loss: Losing even a small amount of weight can significantly reduce the stresses passing through the arthritic joint because the rear of the foot is susceptible to forces that are similar to three to five times body weight during daily activities.
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Comfy Footwear: Comfort footwear, such as those with a shock absorber in the heel, helps lessen the recurrent strain on the subtalar joint.
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Ankle Bracing: Ankle bracing, such as the use of an ankle lacer, or even taping the ankle and the backfoot, can be beneficial since it helps to prevent excessive mobility in the arthritic subtalar joint.
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Icing: After exercise, elevating the leg and wrapping a bag of ice in the area around the ankle and backfoot can help to reduce pain and swelling. Only ten to 15 minutes of ice should be applied at a time.
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Drugs Used to Treat Inflammation (NSAIDs): NSAIDs can lessen a patient's arthritic symptoms if there are no contraindications.
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Acetaminophen: Acetaminophen, given two to three times a day, can aid with subtalar arthritis pain management. It might not be as effective as NSAIDs, yet since it uses a different mechanism to function, it might have an additional impact. Anyone who has liver issues should not consume it.
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Glucosamine Sulfate: Many patients claim that taking Glucosamine sulfate helps them reduce their symptoms, despite the fact that long-term research has not demonstrated any benefits. For any advantage to be noticed, it must be taken every day for six to eight weeks.
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Corticosteroid Injections: Corticosteroid injections often only provide short-term pain relief.
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Hyaluronic Acid (HA) Injections: HA injections have had some effectiveness in treating arthritis in the knee joint, but the subtalar joint has not yet seen similar success.
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Self-Administered Stretching and Strengthening Routines: Exercises to keep the foot muscles as strong as feasible and to maintain the joint's ability to move through a mild range of motion may be helpful.
2. Operative Therapies: Operative therapy is often saved for cases of severe subtalar arthritis where non-operative treatment has failed. The subtalar joint can be cleaned out (debrided), either arthroscopically or more frequently by opening the joint, to treat patients who occasionally have a loose body or an isolated region of injury to the joint. However, most patients with subtalar arthritis have had severe cartilage loss and require fusion of the subtalar joint. A subtalar fusion is different from a subtalar arthrodesis, which involves inserting a plug in the subtalar joint and is ineffective for treating subtalar arthritis.
3. Subtalar Fusion: For patients with severe subtalar arthritis who have tried non-operative treatments without success, subtalar fusion is an effective treatment option. Be aware that, in exchange for pain reduction, subtalar fusion involves uncomfortable movements. Despite the foot losing side-to-side motion, patients frequently report being considerably more active because their discomfort is significantly reduced.
In order to accomplish a subtalar fusion, the joint's remaining cartilage is removed, and then screws and bone grafts are placed across the joint. The fusion of the surfaces of the talus and calcaneus (the heel bone) is the desired outcome. It can be necessary to limit activities for six to ten weeks while also walking with crutches or a knee scooter.
After the injury has healed, weight-bearing is increased until the patient can walk unassisted in normal shoes. Physical therapy is crucial to enhancing balance and ankle motion. Patients should be able to walk significantly better by three to four months following surgery, although they may not see their full benefits for 12 to 18 months.
Conclusion:
The subtalar joint is a hinge-type joint, allowing for flexion and extension but not the side-to-side movement. In a nutshell, the discomfort may produce muscle spasms, in which case the muscles will try to keep the ankle immobile in an effort to preserve the hurting joints. The subtalar joint is stressed and worn down as a result of chronic ankle instability and ankle arthritis.
Rotating the heel inward or outward might cause an unequal distribution of strain on the subtalar joint. Subtalar arthritis is made worse by activities like walking on uneven terrain, which calls for some lateral movement to adjust. The severity of subtalar arthritis determines how it should be treated entirely. Surgery is necessary in severe cases, whereas medical care and home cures are sufficient in moderate situations.
Physiotherapists typically recommend a stretching and strengthening program once the inflammation has subsided in order to increase flexibility and reduce stress on the injured joint. As the discomfort lessens, stronger ranges of motion can be employed to stretch the tissues surrounding the joint, improving ankle mobility.
