Subtalar arthrodesis is a surgical treatment for intractable pain in the ankle, involving the fusion of the subtalar joint inside the ankle. This treatment method is offered as a last resort when the pain cannot be managed by other means. There are risks to this procedure, as with any surgery, and in addition, it will limit free movement of the ankle, potentially causing discomfort or annoyance for the patient. The surgery can be performed by a foot and ankle surgeon or an orthopedic surgeon. It is advisable to select a surgeon with considerable experience with arthrodesis procedures for the best possible outcome.
The subtalar joint in the ankle includes the calcaneus and talus bones. Pain can develop in this joint for a number of reasons, including degenerative bone disease, arthritis, or a fracture. Early treatment options for pain can include pain management drugs, nerve block procedures to limit pain signals, and the use of anti-inflammatory drugs to reduce swelling. Treatment of the underlying medical problem can also be pursued to address the pain, as can physical therapy to gently flex and strengthen the joint.
If these measures do not work, a subtalar arthrodesis may be performed. In this procedure, the patient will be anesthetized and the surgeon will make an incision in the ankle to access the joint. Using pins and other devices, the surgeon joins the bones together, encouraging them to fuse. Eventually, the joint will fuse over and become entirely solid. During a subtalar arthrodesis surgery, the surgeon can also address bone fragments and any other problems that may have developed around the injured joint.
Because this procedure limits ankle motion, care is taken when fusing the bones to select the best possible position for the ankle joint. This is designed to create the least inconvenience for the patient and to stabilize the joint as thoroughly as possible. After the subtalar arthrodesis surgery, the patient will need to avoid putting weight on the ankle while the surgical site heals. Follow up examinations will be used to assess healing and confirm the fusion inside the joint.
If a doctor recommends a subtalar arthrodesis, the patient should ask some questions to make an informed decision about the procedure. Good questions to ask include why the procedure is being recommended, whether there are alternatives, how long the recovery time should take, and how much experience the surgeon has. Patients may want to consider having several surgical consultations to get second opinions, and may also want to ask about the possibility of participating in a clinical trial to study new treatments for subtalar joint pain.