Historic Review of Indications

Reconstruction and arthrodesis play a dominant role in the surgical treatment of various disorders of the hindfoot. Subtalar joint (STJ) arthrodesis has accomplished favorable results in the treatment of various disorders such as primary and secondary osteoarthritis, rheumatoid arthritis, neuromuscular disorders, congenital deformity, and adult hindfoot pathology. Likewise, STJ fusion provides relief for talocalcaneal coalition for the ~3% of the population with this condition. Results of STJ arthrodesis procedures are documented as good to excellent. When performing a hindfoot arthrodesis, there are important goals one must attain to insure a successful outcome, specificially elimination of pain from arthritic and or unstable joints, fusing the foot in a plantigrade position to offer a stable platform for weightbearing, and cessation of a progressive deformity to prevent worsening disability. The STJ allows translation of transverse rotation occurring in the tibia onto the foot. Pathologic stiffening of the joint may not only cause STJ pain, but may also relay discomfort to adjacent joints of the foot and ankle. Persistant ankle pain secondary to a sprain may actually be secondary to talocalcaneal joint pathology. Another clinical presentation of a congenitally stiffened talocalcaneal joint occurring is a ball-and-socket type of ankle joint seen with clubfoot and certain forms of arthrogryposis. More commonly, patients present with difficulty walking on uneven surfaces due to the loss of the normal accommodating motion of an arthritic STJ. Arthrodesis of the STJ has proven to be a reliable salvage procedure to stabilize a deformed or degenerative hindfoot. A review of historic indications and technical applications of the STJ arthrodesis are discussed here. Reported complications as well as preoperative factors associated with successful versus unsuccessful surgical outcomes are examined. Modifications of this procedure are also analyzed such as internal fixation approach and open versus arthroscopic management of the talocalcaneal joint. HISTORIC REVIEW OF INDICATIONS