The most famous golfer in the world recently announced that he underwent a foot surgery called Subtalar fusion. The subtalar joint is a small space between the ankle and the heel bone. Simply put, the ankle joint is responsible for up and down motion, while the subtalar joint is responsible for the side to side adaptive type motions of the hindfoot. A fusion is the permanent stiffening of a painful joint, usually from arthritis. Fusion surgery is very common and effective in smaller joints like the neck, back and foot where joint replacement isn’t an option.
There are many indications for Subtalar fusion, but the most common is arthritis. Think of a joint as a hinge where two bones move. That hinge requires a cushion, called cartilage, to move or function normally. Arthritis occurs when that cushion wears down, creating grinding, popping, swelling and pain. This can happen through gradual overuse or an injury such as a fracture.
Subtalar fusion is usually performed under general anesthesia, takes between one to two hours and is done as outpatient surgery. During the operation an incision is made and the arthritis is removed with power burrs and other instruments. Typically, one or two screws are placed across the joint to provide compression and stability. Postoperatively the patient is weight-bearing for 6 to 8 weeks in a cast followed by 4 to 6 weeks of progressive weight-bearing in a walking boot. The total time to heal varies but can take up to a year.
The patient satisfaction rates for Subtalar fusion are generally high. The surgery is a reliable option to reduce severe pain, but it does have downsides. The biggest downside is that it creates more stiffness in the hindfoot. For example, a patient with a Subtalar fusion still will be able to move the ankle up and down, but will be limited with side to side and circular motions of the foot and ankle. This doesn’t prevent an issue for most moderately active patients, but could create challenges for a professional athlete performing high demand activity and doing extensive walking on uneven terrain. The other downside is that the additional stiffness can put more pressure on the adjacent joints, creating new stresses on those joints. These are a few of the many factors that are considered before Subtalar fusion surgery.
Subtalar joint surgery is a very good option for patients with painful arthritis when balanced against the potential downsides. This is a surgery that I perform in my Baton Rouge podiatry practice. If you think that you have subtalar joint arthritis and have any questions about this condition and its treatment options, please give us a call.
