Subtalar Osteoarthritis

Patient Information

http://www.footeducation.com/foot-and-ankle-conditions/subtalar-arthritis

http://www.patient.co.uk/pdf/4304.pdf

GP Information

Background Information

• Can be post traumatic (after calcaneus fracture), but can also occur in inflammatory and osteoarthritis.
• Patients typically complain of pain on one or both sides of the foot below the malleoli, ankle stiffness, and difficulty walking on uneven ground.
• Examination may reveal restricted subtalar varus/valgus, with tenderness over the sinus tarsi or inferior to the malleoli.

Investigation Guidelines

• Blood tests and radiography are not usually indicated as part of a primary care assessment of suspected osteoarthritis but may be indicated in cases of diagnostic uncertainty.

Management Recommendations

NICE recommend Core treatment should be offered to all patients for a minimum 3/12 prior to referral for surgical opinion.

• Provide verbal and written information to patient. Limit walking on uneven ground.
• Advise strengthening exercises and aerobic fitness training including cycling and swimming.
• Advise comfortable shoes (+/- heel shock absorber) or an ankle brace.

Analgesia should include:

• Regular paracetamol.
• Topical NSAIDs.
• Consider oral NSAIDs, opiods, intra-articular steroid injection (XR-guided). Utilise the NHS shared decision making aids (URL).

Referral Indications

• Diagnostic uncertainty.
• Failure of minimum 3/12 conservative measures.
• Pain, stiffness, reduced function impacting on QoL.
• Referral for physiotherapy / orthotics.
• Referral for steroid injection, consideration of fusion.