1. Introduction

a. Skin Marking

b. Sinus Tarsi Approach

c. Identify and Retract Peroneal Tendons

d. Identify Subtalar Joint

2. Incision and Exposure

a. Scrape Arthritic Cartilage

b. Open Joint Space

c. Perforate Subchondral Plate

3. Prepare Articular Surface

a. Identify Gerdy's Tubercle

b. Harvest Graft

c. Pack with Allograft

d. Closure

e. Add Autograft to Joint Space

4. Bone Grafting

a. Drill Through Calcaneus

b. Measure for Screw Length

c. Insert Screw

d. Repeat for 2nd Screw

e. X-ray Confirmation

5. Subtalar Fusion

6. Closure

7. Discussion

Subtalar arthrodesis is currently the mainstay treatment option for the management of recalcitrant subtalar arthrosis. Arthrosis is a degenerative joint condition that results in a painful, functionally-impaired joint. In the subtalar joint, this typically follows trauma to the hindfoot resulting in talus or calcaneus fractures in particular. Although anatomic reduction of these injuries reduces the chance of later complications, arthrosis is reported even following anatomical repairs. The goal of the fusion in this circumstance is to remove a painful joint. A broad range of both congenital and acquired foot conditions include subtalar arthrodesis as part of their management strategy.

This video article details the methods and techniques involved in subtalar arthrodesis. After an Ollier approach was used to expose the subtalar joint, the subchondral plates were prepared by inserting an autogenous bone graft. Finally, compression was achieved by two lag screws. The process of obtaining an autogenous bone graft from the proximal tibia using a bone harvesting device is also illustrated, and opinions and expectations on the future direction of the management of this arthritic joint condition are discussed.

Watch this full-length, narrated surgical video of a subtalar arthrodesis performed by Dr. DiGiovanni at Massachusetts General Hospital.

Massachusetts General Hospital