Health condition · Clinically reviewed
Subtalar arthritis, post-traumatic hindfoot arthritis — from bracing to subtalar arthrodesis.
Osteoarthritis of the subtalar (talocalcaneal) joint — usually post-traumatic after calcaneal fracture or chronic ankle instability. Modern stratified care: bracing and injections; arthroscopic debridement and subtalar arthrodesis for advanced disease.
Why trust this guide
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Clinically reviewed
Written by our editorial team and reviewed by a registered UK clinician before publication.
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Sourced from guidance
Every claim is checked against NICE, BOFAS or peer-reviewed sources you can see at the end.
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Current for 2026
Reflects current UK foot and ankle practice on bracing, injection therapy and subtalar arthrodesis.
Key facts
Subtalar arthritis at a glance.
The essentials, in plain English — what subtalar arthritis is, why it usually follows an old injury, and what the modern treatment ladder looks like.
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Definition
Subtalar arthritis is osteoarthritis of the subtalar (talocalcaneal) joint — the joint just below the ankle that controls hindfoot inversion and eversion.
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Usually post-traumatic
Most commonly post-traumatic — following a calcaneal fracture, talar fracture or chronic ankle instability rather than primary osteoarthritis.
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Weight-bearing CT
Weight-bearing CT is the gold-standard imaging — it shows joint space loss and hindfoot alignment under physiological load in a way plain films cannot.
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Diagnostic injection
An ultrasound- or fluoroscopy-guided subtalar joint injection is both diagnostic and therapeutic — isolating the subtalar joint as the pain source.
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Subtalar arthrodesis
Subtalar arthrodesis (fusion) remains the gold-standard operation for advanced disease, with high union rates and reliable pain relief.
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Preserves ankle motion
In contrast to tibiotalar (ankle) arthrodesis, subtalar fusion preserves ankle dorsiflexion and plantarflexion — patients keep a functional walking gait.
Why this guide matters
Bracing first, fusion last.
Subtalar arthritis has a clear, stratified pathway — this guide sets out that order so patients understand what comes next and why.
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Bracing and shoe modifications first
An AFO and a rocker-sole shoe reduce hindfoot loading — often the highest-value early intervention.
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Guided injection is diagnostic
An image-guided subtalar injection both confirms the pain source and often gives months of relief.
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Fusion is a reliable operation
For advanced disease, subtalar arthrodesis is the gold standard — with high union rates and preserved ankle motion.
How the diagnosis is made
From painful hindfoot to a clear plan.
The steps a UK GP and foot and ankle team will normally follow, in order — so you know what to expect and why.
Phase 1 · Recognising
Symptoms, examination and trauma history
Phase 2 · Confirming
Weight-bearing X-ray, CT and diagnostic injection
Phase 3 · Managing
Bracing, injections, arthrodesis if advanced
- 01
Recognising
Symptom and trauma history
A careful history — hindfoot pain on uneven ground, previous calcaneal or talar fracture, ankle sprains or chronic instability.
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Recognising
Hindfoot examination
Focused examination of the hindfoot — tenderness over the sinus tarsi, hindfoot alignment and gait assessment.
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Recognising
Subtalar range-of-motion assessment
Passive inversion and eversion of the hindfoot with the ankle stabilised — reduced and painful subtalar motion is characteristic.
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Confirming
Weight-bearing X-ray (Broden’s view)
Standing lateral and Broden’s oblique views of the hindfoot — the first-line imaging to look for subtalar joint space narrowing.
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Confirming
Weight-bearing CT
The gold-standard investigation — assesses joint space loss, subchondral cysts and hindfoot alignment under load.
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Confirming
Ultrasound-guided diagnostic injection
A targeted local anaesthetic and steroid injection into the subtalar joint — confirms the joint as the pain source and gives therapeutic relief.
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Managing
Foot & ankle surgery consultation
For advanced disease refractory to bracing and injection — a specialist opinion on arthroscopic debridement or subtalar arthrodesis.
Typical timeline: 4–8 weeks from first appointment to a settled plan.
Symptoms
What subtalar arthritis actually feels like.
The pattern is more telling than any single symptom — hindfoot pain worse on uneven ground, stiffness on inversion and eversion, and a history of past trauma.
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Hindfoot pain
A deep, aching pain in the hindfoot — often felt around the sinus tarsi, just in front of and below the lateral ankle.
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Pain on uneven ground
Walking on cobbles, grass or uneven surfaces reliably provokes pain — the subtalar joint is loaded most on uneven terrain.
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Subtalar stiffness
A stiff, locked hindfoot — reduced inversion and eversion, often noticed when trying to turn the foot inward or outward.
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Sinus tarsi pain
Point tenderness over the sinus tarsi — the small hollow just in front of the lateral malleolus.
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Lateral hindfoot pain
Pain along the lateral side of the hindfoot, often worse with prolonged standing or walking downhill.
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Limping
An antalgic gait with a shortened stance phase on the affected side — often more obvious on uneven ground.
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Recurrent symptoms
Symptoms that flare with activity and settle with rest — a classic mechanical arthritis pattern rather than a steady inflammatory ache.
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Red flag
Hot swollen hindfoot with fever — think septic joint or acute gout as a differential rather than assuming osteoarthritis.
Treatment
How subtalar arthritis is treated in the UK.
A staged approach — bracing, shoe modification and injections first, with arthroscopic debridement and subtalar arthrodesis reserved for advanced disease.
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Ankle-foot orthosis (AFO)
A rigid or semi-rigid brace that limits subtalar motion — often the first meaningful intervention for moderate disease.
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Rocker-sole shoe
A stiff rocker-bottom sole reduces hindfoot loading through the gait cycle — a simple, well-tolerated modification.
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Physiotherapy
Calf stretching, peroneal and posterior tibial strengthening and gait retraining — supportive rather than curative.
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NSAIDs
Short courses of oral anti-inflammatories for flares — prescribed with gastric protection and the usual cardiovascular caveats.
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Ultrasound-guided subtalar steroid injection
Both diagnostic and therapeutic — image guidance is essential because the joint is deep and narrow.
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Arthroscopic subtalar debridement
A keyhole procedure to remove loose bodies, inflamed synovium and osteophytes — an option for early or moderate disease.
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Subtalar arthrodesis (fusion)
The gold-standard operation for advanced subtalar arthritis — fuses the talus and calcaneus for reliable, long-lasting pain relief.
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Triple arthrodesis (with midfoot arthritis)
Fusion of the subtalar, talonavicular and calcaneocuboid joints — reserved for combined hindfoot and midfoot arthritis or significant deformity.
What this guide is based on
The sources behind every claim on this page.
UK national guidance and specialist society standards, current at the time of last review.
Key references
Guidelines and standards we relied on.
A quiet reminder
This guide is for information, not medical advice.
Your GP, podiatrist or foot and ankle team knows your history and can tell you which parts apply to you. If in doubt, get seen.
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British Orthopaedic Foot and Ankle Society (BOFAS). Standards and patient information on hindfoot arthritis.
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NICE guideline NG226. Osteoarthritis in over 16s: diagnosis and management.
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American Orthopaedic Foot & Ankle Society (AOFAS). Clinical guidance on subtalar arthritis and arthrodesis.
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International weight-bearing CT consensus statements on hindfoot imaging.
Red flags
When hindfoot pain is not just arthritis.
Most subtalar arthritis is mechanical and stratified. These are the situations where a different diagnosis or a post-operative complication needs to be considered.
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Septic subtalar joint
A hot, swollen hindfoot with fever and severe rest pain — needs urgent aspiration and antibiotics, not injection.
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Charcot foot
A red, warm, swollen foot in a person with diabetes or neuropathy — Charcot neuroarthropathy needs immediate offloading.
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Post-op non-union of arthrodesis
Persistent hindfoot pain months after subtalar fusion — imaging may show non-union requiring revision surgery.
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Adjacent-joint arthritis
New pain in the ankle or midfoot after subtalar fusion — adjacent joints take up extra load and can develop secondary arthritis.
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Post-op infection
Increasing pain, wound discharge, redness or fever after surgery — same-day contact with the surgical team.
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Nerve injury (sural)
Numbness or burning along the lateral border of the foot after lateral hindfoot surgery — sural nerve injury needs review.
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Post-op malalignment
Hindfoot that heals in varus or valgus after fusion — causes secondary lateral or medial column pain and may need revision.
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Post-op stiffness
Significant loss of hindfoot motion after arthroscopic debridement — needs review and structured physiotherapy.
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Recurrent post-traumatic arthritis
Progressive hindfoot pain years after a calcaneal or talar fracture — a common trajectory that warrants specialist review.
Living with it
A slow condition, but a very manageable one.
Four things that make the biggest difference day to day — footwear, bracing, load management and timely review.
A quiet reminder
Small changes, kept up, do more than heroic ones.
Rocker soles, bracing and pacing — used consistently — buy years of comfortable walking before surgery ever needs to be discussed.
- 01 Footwear
Stiff soles help
Rocker-bottom shoes and rigid soles reduce subtalar loading through the gait cycle — a simple, high-value change.
- 02 Bracing
Use the AFO consistently
An ankle-foot orthosis only helps if worn — think of it as a tool that buys you comfortable walking, not a permanent commitment.
- 03 Load
Avoid uneven terrain
Cobbles, grass and slopes reliably flare symptoms — planning routes and pacing activity makes a real difference.
- 04 Reviews
Reassess if things progress
If bracing and injections stop working, ask for a foot and ankle surgery opinion — subtalar fusion is a reliable operation.
Frequently asked
Everything we get asked about subtalar arthritis.
Quick answers on imaging, injections, subtalar arthrodesis and what to expect from surgery.
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What causes subtalar arthritis?
It is most commonly post-traumatic — following a calcaneal fracture, talar fracture or chronic ankle instability. Primary osteoarthritis of the subtalar joint does occur but is much less common than the post-traumatic form.
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Why do I need a weight-bearing CT?
Weight-bearing CT is the gold-standard imaging for hindfoot arthritis. It shows joint space loss, subchondral cysts and hindfoot alignment under physiological load — information that plain X-rays and non-weight-bearing CT simply cannot provide.
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What is a subtalar joint injection?
A guided injection of local anaesthetic and steroid into the subtalar joint. It is both diagnostic — because the anaesthetic isolates the joint as the pain source — and therapeutic, often giving months of relief and helping decide if surgery would help.
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What does subtalar arthrodesis involve?
Subtalar arthrodesis fuses the talus and calcaneus, permanently eliminating movement at the arthritic joint. It is a reliable operation for advanced disease, with high union rates and long-lasting pain relief for most patients.
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Will I be able to walk normally after a subtalar fusion?
Yes — the great advantage of subtalar arthrodesis over ankle (tibiotalar) arthrodesis is that ankle dorsiflexion and plantarflexion are preserved. Most patients walk with a near-normal gait, though inversion and eversion are lost.
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What is the red flag I should not ignore?
A hot, swollen hindfoot with fever — this could be a septic subtalar joint, acute gout or, in someone with diabetes or neuropathy, a Charcot foot. Any of these need urgent review rather than an assumption of osteoarthritis.
Related content
Keep reading.
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Tibiotalar arthritis — from bracing to ankle replacement.
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Midfoot arthritis
Osteoarthritis of the midfoot joints — diagnosis and care.
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