Subtalar Arthrodesis



Subtalar Arthrodesis


Simon Lee, MD

Stephen K. Jacobsen, MD


Dr. Lee or an immediate family member serves as a board member, owner, officer, or committee member of the American Orthopaedic Foot & Ankle Society. Neither Dr. Jacobsen nor any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this chapter.

This chapter is adapted from Carr JB: Subtalar arthrodesis, in Flatow E, Colvin AC, eds: Atlas of Essential Orthopaedic Procedures. Rosemont, IL, American Academy of Orthopaedic Surgeons, 2013, pp 515-518.



PATIENT SELECTION




PREOPERATIVE (DIAGNOSTIC) IMAGING

The initial diagnostic workup should include AP, lateral, and axial views of the hindfoot (Figure 1). The hindfoot alignment view should include the distal tibia to delineate calcaneal-tibial alignment (Figure 2). Brodén views may be used to better evaluate the subtalar joint but are most useful intraoperatively to judge implant placement.

The definitive imaging modality for defining the bony anatomy is a CT scan. This will accurately define the presence/severity of arthritis, image adjacent joints, and provide useful information about the alignment of the hindfoot (Figure 3). In complex cases, a three-dimensional image can be obtained and provide a readily understandable method to visualize the anatomy of the situation. The surgeon can also plan the length and direction of implants if desired. The status of healing is also better determined with CT scanning.5 Recently, the availability of weight-bearing CT scans has provided additional ability to evaluate deformity in a more dynamic fashion.

MRI is also useful in imaging the subtalar joint preoperatively. For example, in cases of subtalar arthritic symptoms without obvious pathology on other modalities, MRI may identify areas of bone marrow edema adjacent to the articular surfaces that correlate with symptomatic regions within the joint (Figure 4). MRI is also the best tool for assessing vascularity of the talus in cases of osteonecrosis (eg, after talus fracture).


Feb 2, 2020 | Posted by in ORTHOPEDIC | Comments Off on Subtalar Arthrodesis
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