Introduction An isolated subtalar arthrodesis through a sinus tarsi approach with cannulated screw fixation is safe, reproducible, and effective for specific hindfoot pathology in adults.
Indications & Contraindications
Step 1: Preoperative Planning Perform a comprehensive clinical and radiographic assessment.
Step 2: Patient Positioning Position the patient supine on the operating table with a bump under the ipsilateral hip, to internally rotate the involved leg.
Step 3: Incision Mark a longitudinal incision from just inferior to the tip of the lateral malleolus and extending toward the base of the 4th metatarsal.
Step 4: Approach Expose the subtalar joint by reflecting the extensor digitorum brevis and protecting the peroneal tendons.
Step 5: Joint Preparation Meticulously prepare the subtalar joint using osteotomes and curets down to healthy bleeding subchondral bone.
Step 6: Reduction and Fixation Reduce the subtalar joint into 5° of valgus and fix it with cannulated screws.
Step 7: Wound Closure Meticulously close the wound in layers and place the lower leg in a well-padded plaster back slab with the ankle in a neutral position.
Step 8: Postoperative Care The operatively treated leg is kept immobilized and non-weight-bearing for the first 6 weeks.
Results Numerous retrospective articles have reported high fusion rates and good functional outcomes after isolated subtalar arthrodesis, for all indications.
Pitfalls & Challenges
An isolated subtalar arthrodesis through a sinus tarsi approach with cannulated screw fixation is safe, reproducible, and effective for specific hindfoot pathology in adults.
Subtalar arthrodesis performed for the correct indication is an effective procedure for alleviating symptoms, correcting malalignment, and improving function1,2. It is not as technically demanding as a triple arthrodesis and has the benefit of retaining some hindfoot function3. The most common indication for the procedure is isolated subtalar arthritis, whether primary, posttraumatic, or inflammatory. A …
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