How To Address Subtalar Joint Instability
Emphasizing careful assessment of the etiology and underlying contributing factor to subtalar joint instability, this author reviews pertinent conservative and surgical options for treating this conditin in children and adults. There are two forms of subtalar joint instability. It has been recognized as a cause of ankle symptoms secondary to ligamentous injury or laxity of the subtalar joint. This contributes to instability of the ankle as well. Studies show that sectioning of the calcaneal fibular ligament and cervical ligament of the subtalar joint can lead to as much as a 7 mm increase in talar tilt. Surgical repairs to correct lateral ankle instability should include repair or substitution of the calcaneofibular ligament if subtalar instability is a consideration. The other form of subtalar instability is associated with an excessive range of motion with or without pathology. It can be a process of increased motion that leads to minor pathology and muscular fatigue. Alternatively, it may cause a more complex situation of excessive pronatory motion, leading to collapse of the midtarsal joint and global mechanical problems for the foot and lower extremity. For the purposes of this article, I will consider subtalar joint instability as excessive subtalar joint motion or a position that leads to pain and subjective or objective complaints for a patient.