Subtalar Osteoarthritis
Patient Information
Subtalar osteoarthritis is a degenerative joint condition affecting the subtalar joint — the joint between the heel bone (calcaneus) and the ankle bone (talus) — which is responsible for the side-to-side movement of the foot. When this joint becomes arthritic, it can cause significant pain, stiffness, and difficulty walking on uneven terrain. Mr Matthew Welck is a leading specialist foot and ankle surgeon in London, offering comprehensive management of subtalar osteoarthritis at the RNOH Stanmore, The Wellington Hospital North London, and private clinics in Hertfordshire.
Useful patient resources: Foot Education – Subtalar Arthritis | Patient Information PDF
What is Subtalar Osteoarthritis?
The subtalar joint lies beneath the ankle joint and enables the foot to invert and evert — the rolling motion that allows balance and adaptation to uneven ground. Osteoarthritis of this joint leads to the breakdown of cartilage, causing bone-on-bone friction, inflammation, and progressive pain and stiffness. It can significantly affect quality of life, limiting mobility and participation in daily activities.
Causes of Subtalar Osteoarthritis
- Post-traumatic – The most common cause; typically following a calcaneus (heel bone) fracture that damages the joint surface
- Primary osteoarthritis – Age-related cartilage degeneration without a prior injury
- Inflammatory arthritis – Including rheumatoid arthritis, psoriatic arthritis, or gout
- Biomechanical deformity such as flat foot or heel valgus causing abnormal loading of the joint
- Previous ankle or subtalar joint surgery
Symptoms
- Pain on one or both sides of the foot, below the ankle bones (malleoli)
- Ankle and hindfoot stiffness, particularly in the morning or after inactivity
- Difficulty walking on uneven ground, slopes, or cobblestones
- Swelling around the heel and ankle area
- Examination may reveal restricted subtalar inversion/eversion, tenderness over the sinus tarsi (outer ankle), and tenderness inferior to the malleoli
GP Information
Investigation Guidelines
Blood tests and plain radiography are not usually required as part of a primary care assessment of suspected osteoarthritis but may be indicated in cases of diagnostic uncertainty. Weight-bearing X-rays of the hindfoot are the most useful initial investigation when imaging is felt to be appropriate. CT scanning may be requested by the specialist to assess joint damage in detail prior to surgical planning.
Conservative Management
In line with NICE guidance, core treatment should be offered to all patients for a minimum of 3 months prior to referral for a surgical opinion:
- Verbal and written information about the condition and self-management; advice to limit walking on uneven ground
- Strengthening exercises and low-impact aerobic fitness activities such as cycling and swimming
- Comfortable supportive footwear with a heel shock absorber, or an ankle brace/splint
- Analgesia – Regular paracetamol as a first-line analgesic
- Topical NSAIDs for localised pain relief
- Oral NSAIDs and opioids in refractory cases, following a shared decision-making discussion with the patient
- Intra-articular corticosteroid injection (image-guided) to provide medium-term pain relief
Referral Indications
- Diagnostic uncertainty regarding the cause or extent of joint involvement
- Failure of conservative measures after a minimum of 3 months
- Significant pain, stiffness, and reduced function impacting on quality of life
- Referral for formal physiotherapy or orthotics fitting
- Consideration of image-guided steroid injection or surgical intervention including subtalar joint fusion (arthrodesis)
Surgical Treatment — Subtalar Fusion
The gold standard surgical treatment for advanced subtalar osteoarthritis is subtalar arthrodesis (fusion), which eliminates painful movement in the diseased joint while preserving motion in the other foot and ankle joints. Mr Matthew Welck performs this procedure arthroscopically (keyhole) or using a minimally invasive approach where appropriate, resulting in reduced surgical morbidity and faster recovery. Most patients achieve significant pain relief and improved function following successful fusion.
Book a Consultation in London
To discuss subtalar osteoarthritis diagnosis and treatment options with Mr Matthew Welck in London or North London, please contact the clinic to arrange an appointment at a location convenient to you.