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Foot and Ankle Clinics Sep 2018Arthroscopic subtalar fusion is an excellent approach to subtalar pathologic condition where conservative treatment has failed and a fusion has been indicated. Formal... (Review)
Review
Arthroscopic subtalar fusion is an excellent approach to subtalar pathologic condition where conservative treatment has failed and a fusion has been indicated. Formal contraindications include excessive malalignment and bone loss. The posterior arthroscopic approach is analyzed in this article, including indications, surgical technique, surgical tips, and complications. Excellent results can be expected, including a shorter time to fusion, and faster rehabilitation, including activities of daily living and sports.
Topics: Arthrodesis; Arthroscopy; Biomechanical Phenomena; Humans; Joint Diseases; Subtalar Joint
PubMed: 30097086
DOI: 10.1016/j.fcl.2018.04.007 -
Foot and Ankle Clinics Sep 2018The subtalar joint is divided into the talocalcaneonavicular and the talocalcaneal joint, separated by a conical interosseous tunnel (canalis and sinus tarsi). The... (Review)
Review
The subtalar joint is divided into the talocalcaneonavicular and the talocalcaneal joint, separated by a conical interosseous tunnel (canalis and sinus tarsi). The talocalcaneonavicular joint is a ball-and-socket articulation (coxa pedis). An important part of the coxa pedis is the spring ligament. The canalis and sinus tarsi are occupied by the roots of the inferior extensor retinaculum, cervical ligament, interosseous talocalcaneal ligament, and anterior talocalcaneal ligament. Three-dimensional motion in the subtalar joint complex (eversion/inversion) is guided by the axial alignment of the talus, calcaneus, and navicular; the ligaments; and the shape of the articular surfaces.
Topics: Humans; Ligaments, Articular; Subtalar Joint
PubMed: 30097077
DOI: 10.1016/j.fcl.2018.04.001 -
Orthopaedics & Traumatology, Surgery &... Feb 2016Arthroscopy has become indispensable for performing tibiotalar and subtalar arthrodesis. Now in 2015, it is the gold-standard surgical technique, and open surgery is... (Review)
Review
Arthroscopy has become indispensable for performing tibiotalar and subtalar arthrodesis. Now in 2015, it is the gold-standard surgical technique, and open surgery is reserved only for cases in which arthroscopy is contraindicated: material ablation after consolidation failure, osteophytes precluding a work chamber, excentric talus, severe malunion, bone defect requiring grafting, associated midfoot deformity, etc. The first reports of arthroscopic tibiotalar and subtalar arthrodesis date from the early 1990s. Consolidation rates were comparable to open surgery, but with significantly fewer postoperative complications: infection, skin necrosis, etc. Arthroscopy was for many years reserved to moderate deformity, with frontal or sagittal deviation less than 10°. The recent literature, however, seems to extend indications, the only restriction being the surgeon's experience. Tibiotalar arthrodesis on a posterior arthroscopic approach remains little used. And yet the posterior work chamber is much larger, and initial series showed consolidation rates similar to those of an anterior approach. The surgical technique for posterior tibiotalar arthrodesis was described by Van Dijk et al., initially using a posterior para-Achilles approach. This may be hampered by posterior osteophytes or ankylosis of the subtalar joint line (revision of non-consolidated arthrodesis, sequelae of calcaneal thalamus fracture) and is now used only by foot and ankle specialists. Posterior double tibiotalar-subtalar arthrodesis, described by Devos Bevernage et al., is facilitated by transplantar calcaneo-talo-tibial intramedullary nailing.
Topics: Ankle Injuries; Ankle Joint; Ankylosis; Arthrodesis; Arthroscopy; Fractures, Bone; Humans; Osteophyte; Reoperation; Subtalar Joint; Talus; Tibia
PubMed: 26797006
DOI: 10.1016/j.otsr.2015.06.033 -
Foot and Ankle Clinics Sep 2018Subtalar joint stability is ensured by the osseous geometry of the talocalcaneal joint and the complex array of the ligaments at the medial and lateral aspect of the... (Review)
Review
Subtalar joint stability is ensured by the osseous geometry of the talocalcaneal joint and the complex array of the ligaments at the medial and lateral aspect of the ankle joint, the sinus and canalis tarsi, and the talocalcaneonavicular joint, respectively. There is still a substantial lack of knowledge about the interaction of the ankle and subtalar joint complex. Subtalar joint instability appears to be more frequent than is generally assumed. The diagnosis of chronic subtalar joint instability makes the application of a comprehensive algorithm necessary. There is ongoing debate about the preferable techniques for restoration of subtalar joint stability.
Topics: Biomechanical Phenomena; Humans; Joint Instability; Ligaments, Articular; Subtalar Joint
PubMed: 30097081
DOI: 10.1016/j.fcl.2018.04.005 -
Foot and Ankle Clinics Jun 2015Understanding subtalar joint biomechanics and pathomechanics provides a framework for understanding both common pathologic hindfoot and forefoot conditions and surgical... (Review)
Review
Understanding subtalar joint biomechanics and pathomechanics provides a framework for understanding both common pathologic hindfoot and forefoot conditions and surgical planning. It is important to identify mechanical impairment and to define what mechanical effect is needed to change a pathologic condition. It is also important to know what the initial problem is and what the consequences are in terms of soft tissue or bony stress leading to peritalar injury. Whenever possible, one should try to operate to change pathomechanics and facilitate spontaneous repair of stressed structures.
Topics: Gait; Humans; Ligaments, Articular; Motor Activity; Range of Motion, Articular; Subtalar Joint; Weight-Bearing
PubMed: 26043239
DOI: 10.1016/j.fcl.2015.02.001 -
Clinics in Podiatric Medicine and... Jul 2023The arthroscopic approach provides a manageable postoperative course in terms of wound healing, pain control, and bone healing when compared with an open procedure. In... (Review)
Review
The arthroscopic approach provides a manageable postoperative course in terms of wound healing, pain control, and bone healing when compared with an open procedure. In particular, posterior arthroscopic subtalar joint arthrodesis (PASTA) allows a reproducible and viable alternative to standard lateral-portal subtalar joint (STJ) arthrodesis without violating sinus or canalis tarsi neurovascular structures. Additionally, those patients who have undergone previous total ankle arthroplasty, arthrodesis, or talonavicular joint arthrodesis may be better served with PASTA over open arthrodesis if STJ fusion becomes necessary. This article describes the unique PASTA surgical procedure and its helpful tips and pearls.
Topics: Humans; Subtalar Joint; Arthroscopy; Arthrodesis; Ankle; Ankle Joint
PubMed: 37236684
DOI: 10.1016/j.cpm.2023.02.002 -
Foot and Ankle Clinics Jun 2022One of the most challenging problems facing orthopedic surgeons is persistent pain after surgery and certainly is just as frustrating following hindfoot fusion. The... (Review)
Review
One of the most challenging problems facing orthopedic surgeons is persistent pain after surgery and certainly is just as frustrating following hindfoot fusion. The hindfoot joints consist of the subtalar, talonavicular, and calcaneocuboid (CC) joints. These joints are commonly fused for degenerative changes, deformity correction, inflammatory or neuropathic arthropathy, tarsal coalition, or primarily after trauma. Goals of hindfoot fusion are a painless plantigrade foot capable of fitting in shoes without orthotics or a brace. Many believe that deformity correction is achievable without inclusion of the CC joint. Managing patient expectations is important when counseling a patient especially regarding potential complications.
Topics: Arthrodesis; Foot; Humans; Pain; Subtalar Joint; Tarsal Joints
PubMed: 35680291
DOI: 10.1016/j.fcl.2021.11.019 -
Operative Orthopadie Und Traumatologie Jun 2016Realignment and stabilization of the hindfoot by subtalar joint arthrodesis. (Clinical Trial)
Clinical Trial
OBJECTIVE
Realignment and stabilization of the hindfoot by subtalar joint arthrodesis.
INDICATIONS
Idiopathic/posttraumatic arthritis, inflammatory arthritis of the subtalar joint with/without hindfoot malalignment. Optional flatfoot/cavovarus foot reconstruction.
CONTRAINDICATIONS
Inflammation, vascular disturbances, nicotine abuse.
SURGICAL TECHNIQUE
Approach dependent on assessment. Lateral approach: Supine position. Incision above the sinus tarsi. Exposure of subtalar joint. Removal of cartilage and breakage of the subchondral sclerosis. In valgus malalignment, interposition of corticocancellous bone segment; in varus malalignment resection of bone segment from the calcaneus. Reposition and temporarily stabilization with Kirschner wires. Imaging of hindfoot alignment. Stabilization with cannulated screws. Posterolateral approach: Prone position. Incision parallel to the lateral Achilles tendon border. Removal of cartilage and breakage of subchondral sclerosis. Medial approach: Supine position. Incision just above and parallel to the posterior tibial tendon. Removal of cartilage and breakage of subchondral sclerosis. Stabilization with screws.
POSTOPERATIVE MANAGEMENT
Lower leg walker with partial weightbearing. Active exercises of the ankle. After a 6‑week X‑ray, increase of weightbearing. Full weightbearing not before 8 weeks; with interpositioning bone grafts not before 10-12 weeks. Stable walking shoes. Active mobilization of the ankle.
RESULTS
Of 43 isolated subtalar arthrodesis procedures, 5 wound healing disorders and no infections developed. Significantly improved AOFAS hindfood score. Well-aligned heel observed in 34 patients; 5 varus and 2 valgus malalignments. Sensory disturbances in 8 patients; minor ankle flexion limitations. Full bone healing in 36 subtalar joints, pseudarthrosis in 4 patients.
Topics: Adolescent; Adult; Aged; Arthrodesis; Bone Screws; Bone Wires; Exercise Therapy; Female; Flatfoot; Humans; Male; Middle Aged; Subtalar Joint; Treatment Outcome; Young Adult
PubMed: 26895251
DOI: 10.1007/s00064-016-0438-8 -
Musculoskeletal Surgery Dec 2022Subtalar joint dislocation (1% of all dislocations) is the permanent loss of articular relationships in the talonavicular and talocalcaneal joints, without other... (Review)
Review
BACKGROUND
Subtalar joint dislocation (1% of all dislocations) is the permanent loss of articular relationships in the talonavicular and talocalcaneal joints, without other involvement of the foot. Dislocation can occur medially (85%), laterally (15%), posteriorly (2.5%) and anteriorly (1%). Reduction can be performed by closed or open technique; lateral dislocations often require open reduction because of inclusion of soft tissues or bone fragments. Lateral dislocations are frequently complicated by bone exposure, risk of infection and associated soft tissues injuries.
AIM OF THE STUDY
The aim of this study is to explain main characteristics and to clarify the most important pitfalls of subtalar dislocations.
MATERIALS AND METHODS
We examined 47 articles published in the last thirty years (389 cases). For each dislocation we reviewed its main characteristics: direction, bone exposure, need for open reduction and for surgical stabilisation, associated injuries and method used for diagnosis.
RESULTS
Medial dislocations (68.1%) has greater incidence compared to lateral ones (27.7%). Bone exposure (44.5%), associated lesions (44.5%) and need for surgical reduction (48.2%) are much more represented in lateral dislocation than in the others.
CONCLUSIONS
Subtalar dislocations, especially the lateral one, represent a challenge for surgeons. Lateral subtalar dislocation occurs following high-energy trauma often involving associated injuries. Closed reduction could be unsuccessful and patients must undergo surgical reduction. After reduction CT scan is recommended. Our narrative review confirms these findings.
Topics: Humans; Subtalar Joint; Joint Dislocations; Fractures, Bone; Tomography, X-Ray Computed
PubMed: 35435636
DOI: 10.1007/s12306-022-00746-x -
Orthopaedics & Traumatology, Surgery &... Dec 2016Arthroscopic subtalar arthrodesis is gaining in popularity based on evidence of bone fusion in over 90% of cases, with a shorter time to healing, a simpler postoperative...
Arthroscopic subtalar arthrodesis is gaining in popularity based on evidence of bone fusion in over 90% of cases, with a shorter time to healing, a simpler postoperative course, and fewer complication compared to open surgery. Two arthroscopic techniques have been reported: one with the patient in lateral decubitus and lateral portals and the other with the patient prone and posterior portals. The objective of this technical note is to describe these two techniques, with emphasis on the specific characteristics of each.
Topics: Arthrodesis; Arthroscopy; Humans; Subtalar Joint
PubMed: 27687063
DOI: 10.1016/j.otsr.2016.08.002