Subtalar and midfoot arthritis

Midfoot and hindfoot arthritis are frequently secondary to trauma. Less frequently these conditions are due to deformities. Pain is usually present during walking on uneven ground or impact activities. On physical examination, there is pain directly over the compromised joints. In the case of midfoot arthritis, there is pain in the dorsum of the foot. In the case of subtalar joint arthritis, there is pain on sinus tarsi palpation. Any deformity must be noted, including plano-valgus and cavus-varus feet. Conservative treatments include gel insoles and/or corticoid injections, among others. If conservative treatment fails after 6-12 months surgical intervention should be discussed. Surgical treatment mainly comprises joint arthrodesis. The least amount of joints should be fused to minimize the secondary foot stiffness. In cases where a deformity is present, the correction should be performed through the fusion. For example, in cases of arthritic varus or valgus hindfoot, a corrective subtalar arthrodesis should be performed. In subtalar arthritis secondary to impacted calcaneus fractures with anterior tibio-talar impingement, a distractive subtalar arthrodesis is recommended. These procedures are generally performed using cannulated compressive screws. Fusion rates range from 80 to 90%.