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Ultrasound in Medicine & Biology Jan 2018Our study provides a detailed anatomic and sonographic description of the subtalar joint, a single joint that, anatomically, is divided into the anterior subtalar joint...
Our study provides a detailed anatomic and sonographic description of the subtalar joint, a single joint that, anatomically, is divided into the anterior subtalar joint (ASTJ) and the posterior subtalar joint (PSTJ). Cadaver specimens of the ankle and foot were examined in detail by ultrasound (US), and the subtalar joints of all the specimens were injected with colored latex of a contrasting color under US guidance. Compatible with other studies, examination of the sections revealed lack of communication between the ASTJ and the PSTJ and communication between the PSTJ and the posterior recess of the tibiotalar joint. A recommended list of standardized ultrasound scans was developed using a Delphi consensus process, which allows sonographers to evaluate both the ASTJ and PSTJ from the medial, lateral and posterior aspects. The recommended ultrasound scans were found to be applicable based on a test of agreement between images acquired in cadaver specimens and images acquired in four centers using healthy patients.
Topics: Aged; Cadaver; Female; Humans; Male; Subtalar Joint; Ultrasonography
PubMed: 29122317
DOI: 10.1016/j.ultrasmedbio.2017.09.017 -
Foot and Ankle Clinics Dec 2022Subtalar joint arthrosis is common following intra-articular calcaneus fractures. The appropriate management of pain secondary to posttraumatic arthritis depends on the... (Review)
Review
Subtalar joint arthrosis is common following intra-articular calcaneus fractures. The appropriate management of pain secondary to posttraumatic arthritis depends on the status of the remaining posterior facet articular cartilage, the magnitude of any residual joint displacement and distortions in the overall morphology of the calcaneus. In select circumstances, joint-preserving surgical techniques may be considered including lateral wall exostectomy, far lateral posterior facet joint debridement, and intra-articular osteotomies. When the subtalar joint is not salvageable, some form of arthrodesis procedure is pursued. Occasionally, an extra-articular osteotomy may be necessary in combination with arthrodesis to correct deformity.
Topics: Humans; Subtalar Joint; Calcaneus; Fractures, Malunited; Fractures, Bone; Foot Injuries; Arthrodesis; Ankle Injuries; Osteoarthritis
PubMed: 36368797
DOI: 10.1016/j.fcl.2022.08.001 -
Foot and Ankle Clinics Dec 2021Various surgical techniques are known for the treatment of flexible flatfoot in children after failure of nonsurgical attempts. Data collected in a review of the last... (Review)
Review
Various surgical techniques are known for the treatment of flexible flatfoot in children after failure of nonsurgical attempts. Data collected in a review of the last 10-year period (2010-2020) show that among the 691 feet undergoing subtalar arthroereisis with endorthesis, average age at surgery was 11.40 years and in the 1856 feet that underwent subtalar arthroereisis with calcaneo-stop 11.69 years, while the complications rate was 9.00% and 6.38%, respectively. These data confirm that subtalar arthroereisis with calcaneo-stop may have an advantage over subtalar arthroereisis with endorthesis as the screw is not placed across the subtalar joint but instead into the calcaneus.
Topics: Bone Screws; Calcaneus; Child; Flatfoot; Foot; Humans; Subtalar Joint; Treatment Outcome
PubMed: 34752238
DOI: 10.1016/j.fcl.2021.07.007 -
Clinics in Podiatric Medicine and... Oct 2023Subtalar joint arthrodesis is a commonly used procedure for numerous pathologic conditions in the foot and ankle. Although rarely performed in isolation, this procedure... (Review)
Review
Subtalar joint arthrodesis is a commonly used procedure for numerous pathologic conditions in the foot and ankle. Although rarely performed in isolation, this procedure can provide successful resolution of various lower-extremity complaints. There are traditional approaches to isolated subtalar joint arthrodesis; however, when these fail, the authors recommend alternatives to enhance the success of revisional surgery. These include the use of intramedullary nailing, larger harvest of autograft, and metallic wedge.
Topics: Humans; Bone Transplantation; Subtalar Joint; Arthrodesis; Ankle Joint; Printing, Three-Dimensional
PubMed: 37716742
DOI: 10.1016/j.cpm.2023.05.007 -
Foot & Ankle International Mar 2024The purpose of this study is to investigate the biomechanical effect of medial displacement calcaneal osteotomy (MDCO), subtalar joint fusion (SF), and medial ligament...
BACKGROUND
The purpose of this study is to investigate the biomechanical effect of medial displacement calcaneal osteotomy (MDCO), subtalar joint fusion (SF), and medial ligament reconstruction (MLR: deltoid-spring ligament) in a severe flatfoot model. We hypothesized that (1) combination of MDCO and SF improves the tibiotalar and foot alignment in severe progressive collapsing foot deformity (PCFD) cadaver model. (2) However, if a residual valgus heel alignment remains after MCDO and SF, it can lead to increased medial ligament strain, foot malalignment, and tibiotalar valgus tilt, which will be mitigated by the addition of MLR.
METHODS
Ten fresh-frozen cadaveric foot specimens were used to create a severe flatfoot model. The foot alignment changes, including the talo-first metatarsal angle in the axial and sagittal planes, subtalar angle, and tibiotalar angle in the coronal plane, were measured. The angles were measured at the initial condition, after creating the severe flatfoot model, and after each successive reconstructive procedure in the following order: (1) MDCO, (2) SF, and (3) MLR.
RESULTS
Tibiotalar valgus tilt was decreased with the MDCO procedure: 4.4 vs 1.0 degrees ( = .04). Adding in situ SF to the MDCO led to increased tibiotalar tilt to 2.5 degrees was different from the initial condition ( = .01). Although the tibiotalar valgus tilt was significantly decreased after adding the MLR to the MDCO/SF procedure compared with the severe flatfoot model (0.8 vs 4.4 degrees, = .03), no significant difference in the tibiotalar valgus tilt was observed between MDCO/SF and MDCO/SF with MLR.
CONCLUSION
Our results demonstrated that MDCO significantly improved forefoot abduction and medial arch alignment, with no significant additional improvement observed with addition of SF. Following SF, a residual valgus heel alignment can contribute to subsequent tibiotalar valgus tilt. The addition of MLR did not show significantly decreased tibiotalar valgus tilt following SF.
CLINICAL RELEVANCE
Residual valgus heel alignment after subtalar joint fusion in the surgical treatment of PCFD can lead to increased medial ligament strain. Although MLR might be considered for providing medial stability, it may not necessarily prevent the development of tibiotalar valgus tilt.
Topics: Humans; Flatfoot; Subtalar Joint; Foot Deformities; Foot; Ligaments, Articular
PubMed: 38240174
DOI: 10.1177/10711007231220940 -
Foot and Ankle Clinics Jun 2024Although most commonly found in the knee, elbow, and talar dome, osteochondral lesions can also be found in the subtalar joint and can occur due to either high or low... (Review)
Review
Although most commonly found in the knee, elbow, and talar dome, osteochondral lesions can also be found in the subtalar joint and can occur due to either high or low energy trauma. Diagnosis of these lesions in the subtalar joint is typically confirmed with advanced imaging such as computerized tomography and MRI. Although there are a few published case reports, there is otherwise very limited literature on the prevalence, treatment options, prognosis, or outcomes for patients with osteochondral lesions of the subtalar joint, and thus further research is required in this area.
Topics: Humans; Subtalar Joint; Prognosis; Magnetic Resonance Imaging; Tomography, X-Ray Computed; Cartilage, Articular
PubMed: 38679435
DOI: 10.1016/j.fcl.2023.07.002 -
Foot and Ankle Surgery : Official... Apr 2019Although it has been proposed that in mid-stage ankle osteoarthritis, the subtalar joint can compensate for deformities above the ankle joint, the evidence is weak. We...
BACKGROUND
Although it has been proposed that in mid-stage ankle osteoarthritis, the subtalar joint can compensate for deformities above the ankle joint, the evidence is weak. We thus investigated subtalar joint alignment in different stages of ankle osteoarthritis using weightbearing computed tomography (CT) scans.
METHODS
The subtalar joint of 88 patients with osteoarthritis of the ankle joint and a control group of 27 healthy volunteers were assessed. Subgroups were performed according to the ankle deformity (varus and valgus) and stage of ankle joint osteoarthritis. Subtalar joint alignment was assessed on weightbearing CT scans.
RESULTS
A more valgus subtalar joint alignment was found in patients with varus ankle osteoarthritis. No significant difference of the subtalar joint alignment was evident when comparing different stages of ankle osteoarthritis.
CONCLUSIONS
Varus ankles compensate in the subtalar joint for deformities above the ankle joint. Compensation does not correlate with the stage of ankle osteoarthritis.
Topics: Ankle Joint; Female; Humans; Male; Middle Aged; Osteoarthritis; Radiography; Subtalar Joint; Tomography, X-Ray Computed; Weight-Bearing
PubMed: 29409290
DOI: 10.1016/j.fas.2017.10.004 -
Foot and Ankle Clinics Jun 2015Subtalar tarsal coalition is an autosomal dominant developmental maldeformation that affects between 2% and 13% of the population. The most common locations are between... (Review)
Review
Subtalar tarsal coalition is an autosomal dominant developmental maldeformation that affects between 2% and 13% of the population. The most common locations are between the calcaneus and navicular and between the talus and calcaneus. If prolonged attempts at nonoperative management do not relieve the pain, surgery is indicated. The exact surgical technique(s) should be based on the location of the pain, the size and histology of the coalition, the health of the other joints and facets, the degree of foot deformity, and the excursion of the heel cord.
Topics: Adolescent; Age Factors; Child; Foot Deformities; Humans; Subtalar Joint
PubMed: 26043243
DOI: 10.1016/j.fcl.2015.02.005 -
The Journal of Foot and Ankle Surgery :... 2023The use of subtalar arthrodesis procedures has been widely implemented to relieve hindfoot issues after failure of conservative treatments; however, fusion failures...
The use of subtalar arthrodesis procedures has been widely implemented to relieve hindfoot issues after failure of conservative treatments; however, fusion failures persist in some patients with certain risk factors. Currently, surgeons utilize cannulated screws in these arthrodesis procedures to immobilize the subtalar joint. Recent clinical studies have demonstrated improved fusion outcomes in at-risk patients using sustained dynamic compression devices in the tibiotalocalcaneal complex. These devices utilize pseudoelastic nitinol which enables sustained dynamic compression when faced with postoperative bone resorption, joint settling, and bone relaxation. While the clinical success of these devices has been established in the tibiotalocalcaneal complex, the ability of sustained dynamic compression devices to apply joint compression in the subtalar joint has not been quantified. As such, the goals of this study were to (1) compare the ability of static compression devices and sustained dynamic compression devices to apply joint compression and (2) assess the impact of device trajectory on joint compression. A custom mechanical testing fixture was utilized to test the compression applied across the subtalar joint by one sustained dynamic compression device (in anterior and posterior trajectories) as compared to 2 cannulated screws (in both parallel and diverging trajectories). Testing revealed the sustained dynamic compression devices generated 53% greater compression as compared to the static compression devices, despite single versus dual device usage, respectively. Additionally, both types of devices applied joint compression forces in an insertion trajectory-independent manner. These data illustrate the ability of a single SDC device to maintain significantly improved joint compressive forces as compared to 2 static cannulated screws, regardless of insertion trajectory. These SDC devices may be of particular interest for at-risk patients or in revision cases.
Topics: Humans; Subtalar Joint; Bone Screws; Pressure; Arthrodesis; Risk Factors; Ankle Joint
PubMed: 37088274
DOI: 10.1053/j.jfas.2023.04.005 -
Foot & Ankle International Jul 2021The outcomes of revision subtalar arthrodesis have received relatively little focus in research compared with primary subtalar arthrodesis outcomes. This study aimed to...
BACKGROUND
The outcomes of revision subtalar arthrodesis have received relatively little focus in research compared with primary subtalar arthrodesis outcomes. This study aimed to assess the midterm clinical and radiologic results of subtalar joint revision arthrodesis and to analyze the risk factors that might influence the outcome of this procedure.
METHODS
We performed a retrospective review of 20 patients after subtalar joint revision arthrodesis for malunion, using interposition of iliac crest bone graft. The mean age was 55.75 years and the average follow-up lasted for 48.93 months. Eighty-five percent of the patients had at least 1 risk factor identified prior to revision. Patients' satisfaction and functional outcomes were evaluated with the American Orthopaedic Foot & Ankle Society Scale (AOFAS), the Foot and Ankle Outcome Score (FAOS), the Foot Function Index (FFI), and dynamic pedobarography.
RESULTS
A fusion rate of 80% was recorded whereas 20% of the cases ended with a painful pseudarthrosis requiring additional surgery. Pedobarographic measurements demonstrated that loading has a propensity toward the lateral column, but no substantial effect on the gait of patients. In this group, the following patient-reported outcomes were observed: 70% of the patients were satisfied, 20% of the patients found the result fair, and 10% were not satisfied with the results. Compared with the preoperative evaluation, postoperative functional scores showed significant improvement on the FOAS, AOFAS, and FFI outcome scales.
CONCLUSION
Revision arthrodesis of the subtalar joint remains a challenging issue with a relatively high rate of nonunion, especially in a population of patients with multiple risk factors.
LEVEL OF EVIDENCE
Level IV, retrospective case series.
Topics: Arthrodesis; Humans; Middle Aged; Reoperation; Retrospective Studies; Subtalar Joint; Treatment Outcome
PubMed: 33940969
DOI: 10.1177/1071100721995187