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PubMed2006

Arthroscopy of the subtalar joint and arthroscopic subtalar arthrodesis.

Subtalar arthroscopy has become a valuable adjunct to the tools used in lower extremity surgery. For the past 25 years, ankle arthroscopy has been in vogue for treating a variety of conditions. Subtalar arthroscopy has more treatment limitations and is more technically difficult to perform than ankle arthroscopy because of the anatomic confines and structure of the subtalar joint. Most procedures are performed on the posterior aspect of the subtalar joint. The subtalar joint is composed of three articulations (posterior, middle, and anterior facets) and is surrounded by a variety of intra-articular and extra-articular ligaments, whose anatomy must be fully understood before attempting this procedure. Subtalar arthroscopy may be indicated for diagnostic purposes and for débridement of synovial impingement syndromes in the sinus tarsi. It may be used to examine loose bodies or osteochondral lesions, to address fractures of the lateral process of the talus, and to evaluate subtalar instability to determine appropriate stabilization methods. Arthroscopic subtalar arthrodesis also has gained credibility over the past 10 years as an acceptable surgical procedure. Arthroscopic evaluation of subtalar instability is useful in planning the appropriate stabilization. Subtalar arthroscopy is usually performed with the patient in the lateral decubitus position without traction. Anterior and posterior portals as well as an accessory anterior portal are usually necessary to perform all of the above procedures. Because of the limited confines of the joint, care must be taken to prevent any articular cartilage damage. When performing subtalar arthroscopy in conjunction with ankle arthroscopy, the subtalar arthroscopy should be performed first to avoid excessive extravasation from the ankle arthroscopy, which could obscure entry to the subtalar joint. Complications of subtalar arthroscopy are similar to those encountered in ankle arthroscopy, such as damage to the sural and superficial peroneal nerves.

Arthrodesis↗

PubMed1996

Occult fractures following subtalar joint injuries.

Subtalar joint dislocations, although not common, have been increasing in frequency over the last decade. Generally, subtalar joint dislocation can be treated successfully with closed reduction and a short period of cast immobilization. The majority of patients will suffer minimal disability, with subtalar joint stiffness as the primary complaint. This report includes four cases of suspected joint dislocation or subluxation with occult intra-articular fractures identified only by CT scan following essentially normal radiographs. Evidence seems to indicate that CT scanning in patients with suspected subtalar joint subluxation or dislocation and normal radiographs is justified.

Adult↗

PubMed1991

Synovectomy-arthroplasty as an alternative to triple arthrodesis in the management of subtalar joint pain.

Subtalar joint synovectomy-arthroplasty represents an intermediate intervention between more traditional conservative and surgical techniques. Localization of pathology to the structures of the subtalar joint is essential. The likelihood of operative success is predicted by a prolonged remission of symptoms following the injection of steroid and local anesthesia within the subtalar joint. The procedure reduces pain and swelling while increasing ambulatory capacity. No appreciable increase in subtalar joint motion occurs.

Arthrodesis↗

PubMed2006

Arthroscopy of the posterior subtalar joint.

The subtalar joint is a complex and functionally important joint of the lower extremity. It plays a major role in the movement of inversion and eversion of the foot. With the development of small-joint arthroscopes and instrumentation, surgeons became interested in posterior subtalar joint arthroscopy. Diagnostic and therapeutic indications for this technique have increased; however, arthroscopic subtalar surgery is technically difficult and should be performed by an experienced arthroscopist. The number of reports dealing with posterior subtalar arthroscopy remains relatively small.

Arthroscopy↗

PubMed1993

Biomechanics of the subtalar joint complex.

The subtalar joint complex is formed by the posterior talocalcaneal joint and the acetabulum pedis lodging the talar head. The basic motion at the joint is that of male ovoid surfaces moving over female ovoid surfaces and vice versa. The motion generated at the joint is that of flexion-supination-adduction or extension-pronation-abduction. The subtalar motion is generated by the contour and orientation of the articular surfaces and is guided by the intrinsic ligaments: the interosseous talocalcaneal ligament of the canalis tarsi and the cervical ligament. Further support is provided by the extrinsic ligaments: the calcaneofibular ligament and the tibiocalcaneal fascicle of the deltoid ligament. Under tibiotalar vertical loading with internal rotation, the subtalar joint complex is in a close-pack position with maximum talar head surface contact in the acetabulum pedis. The component ligaments of the latter are under maximum tension. The posterior talocalcaneal surfaces are interlocked laterally.

Biomechanical Phenomena↗

PubMed1995

Subtalar joint dislocations.

Dislocations of the subtalar joint are rare injuries. The anatomy, pathophysiology, treatment, and prognosis of subtalar joint dislocations have been well described in the literature. The purpose of this paper is to review the current literature on subtalar joint dislocations, as well as outline those aspects of the anatomy, pathomechanics, and treatment pertinent to care of the patient with subtalar joint dislocation. In addition, complications and obstacles to reduction are described. Subtalar joint dislocations, although not common, have increased in frequency over the last decade. Generally, they can be treated successfully with closed reduction and a short period of cast immobilization. The majority of patients will suffer some disability with subtalar joint stiffness the primary complaint. Associated intra-articular fractures increase the risk of posttraumatic arthrosis.

Biomechanical Phenomena↗

PubMed1989

Instability of the subtalar joint.

Instability of the subtalar joint can follow inversion stress injuries to the lateral ankle and hindfoot. Ligaments involved in the injury include the calcaneofibular, lateral talocalcaneal, cervical, interosseous talocalcaneal, or a combination. Although the problem most often occurs in conjunction with lateral ankle instability, it may be an isolated problem and it is not corrected equally well by the various lateral ankle ligament reconstructions. Techniques available for diagnosis include routine stress radiographs of the ankle, which also include the subtalar joint, specific subtalar stress radiographs, stress tomograms, fluoroscopy, or subtalar arthrograms. Once diagnosed, subtalar instability symptoms can be treated by either nonoperative or operative means.

Fluoroscopy↗

PubMed1996

Chronic laxity of the subtalar joint.

Chronic laxity of the subtalar joint derives from the functional significance of the joint with the talo-calcaneal interosseous ligament as the articular "pivot." The laxity of the subtalar joint is usually associated with traumatic or degenerative pathology of the interosseus ligament. The characteristic pain is present along the sinus tarsi and at times also more proximally along the posterior subtalar joint. Radiographic examination is not significant; however, with arthrography, the normal synovial recess of the posterior subtalar joint corresponding to the sinus tarsi is not visualized. With magnetic resonance imaging it has been possible to document structural alterations of ligament. Reconstruction of the interosseus talo-calcaneal ligament has a reasonable expectation of success. The author presents the results of this treatment in 47 operations (44 patients, 3 bilateral) between January 1982 and June 1992.

Adolescent↗

PubMedDate not supplied

The subtalar joint axis locator: a preliminary report.

A new clinical device, the subtalar joint axis locator, was created to track the three-dimensional location of the subtalar joint axis during weightbearing movements of the foot. The assumption was that if the anterior exit point of the subtalar joint axis is stationary relative to the dorsal aspect of the talar neck, then, by performing radiographs of the feet with the subtalar joint axis locator in place on the foot, the ability of the locator to track rotations and translations of the talar neck and thus the subtalar joint axis in space could be approximated. In this preliminary study of two adults, the subtalar joint axis locator accurately tracked the talar neck position during weightbearing rotational motions of the subtalar joint. The device was also used in a series of subjects to determine its dynamic capabilities. It is possible, then, that the subtalar joint axis locator can reliably track the spatial location of the subtalar joint axis during weightbearing movements of the foot.

Adult↗

PubMedDate not supplied

True posterior dislocation of subtalar joint: a case report.

Posterior dislocation subtalar joint is rare and usually results from a high-velocity injury. Previous reports of all complete posterior dislocations of the subtalar joint have had some degree of a rotational component. We report a case of a true complete posterior dislocation of subtalar joint with no rotation.

Adult↗

PubMed2001

Sonographic measurement of instability of the subtalar joint.

A sonographic method of measuring instability of the subtalar joint was developed. After defining reference points, we determined a sonographic fibulo-trochlear angle. This angle was measured in a neutral position and under an inversion stress position. A ratio q representing the relationship between the fibulo-trochlear angle measured in the neutral position and under stress, was determined. The method was tested on volunteers with clinically and radiologically stable subtalar joints and a control group with unstable subtalar joints. The stress radiograph using the Zwipp method was utilized for radiologic correlation. A sonographic ratio q>1.6 correlated with a radiological unstable subtalar joint. The borderline zone in which there was an overlap of stable and unstable subtalar joints was characterized by a q value of 1.2-1.6. A ratio q<1.2 correlated with a stable subtalar joint.

Cadaver↗

PubMed2000

Experimental study of the subtalar joint axis: preliminary investigation.

An experimental study of the subtalar joint has been conducted with the aim of establishing its axis of movement as well as analysing the associated movement. For description of the axis, CT data for five positions of a single foot were reconstructed using a 3D programme, the 3D data was processed by Patran software. Measures of angular displacements were made from three amputated feet placed in a specially constructed foot frame. Four instantaneous axes of movement could be defined. Calculation of displacements showed an important rolling of the calcaneus (45 degrees). Tacking was evident in inversion, with an opposite displacement between the front and rear part of the calcaneus, whereas during eversion tacking affected only the rear part of the bone: these results were confirmed by 3D reconstructions. Henke's axis was described as that for the talonavicular joint, but acceptable for the subtalar joint. Several authors investigating the coordinates of this axis have reported large differences and described screw-like movements, the latter being incompatible with a fixed axis: instantaneous axes, however are compatible with a screw-like movement. The subtalar joint appears to work as a pivot joint during inversion and as a plane joint during eversion. Although Henke's axis has pedagogical value the subtalar joint has a series of instantaneous axes.

Adult↗

PubMed1989

Rigid subtalar joint--a radiographic spectrum.

A painful or rigid subtalar joint is a common clinical problem. Computed tomography (CT) has been shown to be useful in evaluating tarsal coalition, but several other pathologic processes with a similar clinical presentation may affect the subtalar joint. Findings from 45 radiographically abnormal subtalar joints are presented, including examples of three different patterns of subtalar tarsal coalition, arthritis, infection, trauma and postsurgical changes. Knowledge of different causes of subtalar pathology may permit ready explanation of symptomatology related to the subtalar joint.

Humans↗

PubMed2003

Role of passive structures in the mobility and stability of the human subtalar joint: a literature review.

The subtalar joint plays a fundamental role in the transmission of loads between the leg and the foot. Although anatomical structures of this joint have been described extensively, much ambiguity about their location, shape, and function still persists. There is also disagreement regarding mobility, for example, whether the joint can be considered a hinge, screw-like, or a multiaxial joint. The most relevant studies from the literature are reported and the main experimental observations discussed. Recent studies have described the subtalar joint as a structure with no degrees of unresisted freedom, i.e., motion from the single neutral position is attained only by deformation of the ligaments and of the articular surfaces.

Biomechanical Phenomena↗

PubMed1988

The three-dimensional kinematics and flexibility characteristics of the human ankle and subtalar joints--Part I: Kinematics.

The in-vitro, three dimensional kinematic characteristics of the human ankle and subtalar joint were investigated in this study. The main goals of this investigation were: 1) To determine the range of motion of the foot-shank complex and the associated range of motion of the ankle and subtalar joints; 2) To determine the kinematic coupling characteristics of the foot-shank complex, and 3) To identify the relationship between movements at the ankle and subtalar joints and the resulting motion produced between the foot and the shank. The tests were conducted on fifteen fresh amputated lower limbs and consisted of incrementally displacing the foot with respect to the shank while the motion of the articulating bones was measured through a three dimensional position data acquisition system. The kinematic analysis was based on the helical axis parameters describing the incremental displacements between any two of the three articulating bones and on a joint coordinate system used to describe the relative position between the bones. From the results of this investigation it was concluded that: 1) The range of motion of the foot-shank complex in any direction (dorsiflexion/plantarflexion, inversion/eversion and internal rotation/external rotation) is larger than that of either the ankle joint or the subtalar joint.; 2) Large kinematic coupling values are present at the foot-shank complex in inversion/eversion and in internal rotation/external rotation. However, only a slight amount of coupling was observed to occur in dorsiflexion/plantarflexion.; 3) Neither the ankle joint nor the subtalar joint are acting as ideal hinge joints with a fixed axis of rotation.; 4) Motion of the foot-shank complex in any direction is the result of rotations at both the ankle and the subtalar joints. However, the contribution of the ankle joint to dorsiflexion/plantarflexion of the foot-shank complex is larger than that of the subtalar joint and the contribution of the subtalar joint to inversion/eversion is larger than that of the ankle joint.; 5) The ankle and the subtalar joints have an approximately equal contribution to internal rotation/external rotation movements of the foot-shank complex.

Algorithms↗

PubMed1995

Arthroscopy of the subtalar joint: establishing a medial portal.

One of the recently introduced procedures for studying the posterior subtalar joint is subtalar arthroscopy. There is no reference in the literature to the possibility of a medial portal that might be used either for arthroscopic insertion, probing, or instrumental manipulation. The two portals mentioned in the literature are the anterolateral and the posterolateral portals. For evaluating the possibility of establishing a medial portal, six embalmed adult cadaver feet were used to study the anatomical relations to the proposed medial portal. The subtalar joints of another six fresh adult cadaver feet were then arthroscoped, after distraction of the joint, using the anterolateral, posterolateral, and medial portals. Findings indicated that the medial portal gives good visualization of the posterior subtalar joint. Clinical application has not yet been assessed.

Adult↗

PubMedDate not supplied

Lateral subtalar joint dislocation: a case with calcaneal fracture.

Subtalar joint dislocation is a relatively rare injury, with lateral dislocation occurring less frequently than medial dislocation. Associated fractures alter the treatment plan and the prognosis, but they are often missed on plain film radiographs. A brief review of the anatomy, pathomechanics, treatment, prognosis, and complications of subtalar joint dislocation is presented. An interesting case of lateral subtalar joint dislocation with an associated calcaneal fracture not evident on plain film radiographs but delineated with computed tomography is presented.

Calcaneus↗

PubMed1993

Reliability of open and closed kinetic chain subtalar joint neutral positions and navicular drop test.

Subtalar joint (STJ) measurements are commonly made in the clinic to assess foot and ankle positions because of the high incidence of lower extremity dysfunctions. The purposes of this study were to investigate the intratester and intertester reliability of the open kinetic chain subtalar joint neutral (OKC STJN) and closed kinetic chain subtalar joint neutral (CKC STJN) positions and the navicular drop test (NDT). Two inexperienced testers performed repeated measurements on 15 subjects (N = 30 feet) during two testing sessions. Intratester and intertester reliability (ICC 1,1) and standard error of measurement (SEM) were determined for each dependent variable. For OKC STJN, the intratester ICC values were .06 and .27, and the intertester ICC value was .00. The intratester SEM values were 1.81 and 2.29 degrees, and the intertester was 2.51 degrees. The CKC STJN intratester ICC values were .14 and .18, with SEM values of 2.46 and 2.40 degrees. The intertester CKC ICC value was .15, with an SEM of 2.43 degrees. For the NDT, the intratester ICC values were .61 and .79, and the SEM values were 1.92 mm and 2.57 mm. The intertester ICC value was .57 and the SEM was 2.72 mm. The results reveal that both OKC and CKC STJN yield poor intratester and intertester reliability and the NDT yields poor to moderate intratester reliability and poor intertester reliability. We conclude that these foot and ankle measurements are not reliable when performed by inexperienced testers. Therefore, clinicians should practice these measurement techniques and determine their measurement error.

Adult↗