Subtalar Osteoarthritis

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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.