Living with foot pain can be a real challenge, especially when the subtalar joint is involved. Often overshadowed by its more prominent sibling, the tibiotalar joint, the subtalar joint can become a source of significant pain and disability due to arthritis. In such cases, the consideration of subtalar fusion may arise. But the question persists: Is surgery really necessary? Let’s unravel the complexities surrounding this less-discussed joint.
Understanding the Subtalar Joint
The subtalar joint, located beneath the primary ankle joint, comprises three distinct small joints or facets. These facets play a crucial role in adjusting the heel and foot side to side, facilitating stable movement on uneven terrain.
Unpacking Subtalar Arthritis
Arthritis, a condition characterized by joint surface damage, can affect the subtalar joint. The cartilage in this joint serve as a cushion, and when it gets injured, pain and bone spurs may develop. Typically, the pain is felt in the back of the foot, both on the outside and inside, manifesting as an ache below the main ankle joint after physical activity.
Decoding Subtalar Fusion
Subtalar fusion involves immobilizing the subtalar joint using screws or plates, aiming to alleviate pain by restricting any movement in the area. But what does the recovery process look like? How long before you can put weight on the leg, and can you resume activities like running?
Recovery After Subtalar Fusion
It takes 1 1/2 to 4 months before full weight can be put on the leg, with complete healing and a return to normal activities requiring about a full year.
Running After Subtalar Fusion
Running post subtalar fusion is discouraged. The forces exerted during running may overload adjacent joints, leading to conditions like “Adjacent Segment Disease” (ASD), which accelerates arthritis in neighboring joints.
Assessing the Success of Ankle Fusions
One critical question arises: Can ankle fusion eliminate pain, and are foot fusions genuinely successful? Surprisingly, high-level research on this procedure’s efficacy is lacking, with an early study revealing a staggering 48% complication rate.
In clinical experience, while the subtalar joint pain often subsides post-surgery, the long-term issue lies in ASD, manifesting as arthritis in the joints above or below the fused subtalar joint.
Exploring Alternatives: Can Subtalar Arthritis Be Treated Without Surgery?
The answer is often affirmative. Addressing loose ankle ligaments, a common issue leading to subtalar joint problems, can be achieved through injections of stem cells or platelets. These injections aim to tighten lax ligaments, preventing excessive motion in the subtalar joint that can damage the cartilage and necessitate fusion.
The Role of Ankle Ligaments
Two crucial ligaments supporting the subtalar joint are the deltoid ligament and the sinus tarsi ligaments.
The Deltoid Ligament
Often referred to as the “duct tape” on the inside of the ankle, the deltoid ligament complex provides crucial support to the subtalar joint.
Sinus Tarsi Ligaments
These ligaments, residing in a cavity on the outside of the foot called the sinus tarsi, stabilize the subtalar joint.
OrthoBiologics: A Non-Surgical Approach
The use of OrthoBiologics, such as high-dose platelets or bone marrow stem cells, has been successful in treating subtalar joint arthritis. Precise ultrasound and x-ray-guided injections target ligaments, promoting healing and tightening to stabilize the joint. Additionally, injections into the joint and bone treat the chemical imbalances in the arthritic joint and surrounding damaged bone.
Conclusion
In conclusion, while subtalar fusion may be necessary in some cases, a majority of patients advised to undergo this invasive surgery can potentially avoid it through less invasive alternatives. The subtalar joint, often neglected, proves to be a complex entity, and understanding its nuances is crucial in making informed decisions about treatment.
FAQs
1. Can subtalar fusion completely eliminate pain?
Subtalar fusion may alleviate pain in the short term, but long-term issues such as Adjacent Segment Disease (ASD) may arise.
2. How long is the recovery period after subtalar fusion?
Full weight-bearing typically takes 1 1/2 to 4 months, with complete healing requiring about a year.
3. Is running advisable after subtalar fusion?
Running is not recommended post subtalar fusion, as it can accelerate arthritis in adjacent joints.
4. Are there successful alternatives to subtalar fusion?
Yes, addressing loose ankle ligaments through injections of stem cells or platelets can often be a successful alternative.
5. How common is subtalar joint arthritis, and can it be prevented?
Subtalar joint arthritis is relatively common, often resulting from accumulated wear and tear. Preventive measures include addressing ligament laxity and early intervention with OrthoBiologics.
