Subtalar arthritis can be defined as a degenerative disease of the subtalar joint (STJ) situated below the ankle joint and involves the talus and calcaneus bones in the foot. This joint is essential for side-to-side foot movement, and if affected by arthritis, it will severely affect mobility and the quality of life.
Subtalar Arthritis Causes
In many cases, the development of subtalar arthritis is due to various factors that include traumatic incidents, degeneration or other medical issues. Here are some of the primary causes:
Trauma
Traumatic injuries are among the leading causes of subtalar arthritis. Injuries such as fractures, severe sprains or dislocations of the ankle and foot can cause direct trauma to the subtalar joint. It is a well-established fact that post-traumatic arthritis occurs as a result of a change in the mechanics of the joint and additional stress on the cartilage. This type of arthritis may occur months or even years after the injury.
Rheumatoid Arthritis
Rheumatoid arthritis is an inflammatory disease that affects the joints and is considered an autoimmune disorder. It does not matter which joint in the body the affliction occurs; it can strike the subtalar joint.
Osteoarthritis
OA is a prevalent type of arthritis that is visible with age and joint wear and tear. Some causes of osteoarthritis in the subtalar joint are obesity, repetitive stress from engaging in physical activities and genetic factors.
Post-surgical Complications
Fracture repair, ligament reconstruction, and corrective surgeries on the foot or ankle are some of the causes of subtalar arthritis. The surgery can change the normal biomechanics of the foot and load more stress onto the STJ, thus causing its wear and tear. This is especially true when the surgical operation fails to address the joint’s placement and functionality.
Congenital Abnormalities
Some of the congenital foot deformities that are known to cause predisposition to subtalar arthritis include abnormalities like flatfoot or high arches that can change the pattern of the forces being transmitted through the foot, thus increasing the load on the subtalar joint. Prolonged stress gradually results in the wear and tear of the joints and the development of arthritis.
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Subtalar Joint Pain Symptoms
Subtalar arthritis has several symptoms and mainly includes limited ability to move it. Common symptoms include:
Pain
Subtalar arthritis is defined by pain alongside potential additional signs and symptoms linked to the condition. This discomfort is often worsened by walking, jogging, or standing for an extended period. More intense pain can be experienced when the patient walks or goes up slopes and other inclined surfaces because these actions place extra stress on the subtalar joint.
Swelling
Swelling around the subtalar joint is still another manifestation that may be experienced by the patient. The joint may be red or sometimes a little swollen, and the skin around the joint may become sensitive to touch. Pain and stiffness of the joint may be accompanied by warmth and redness, which suggest that the joint has been inflamed.
Stiffness
Restricted mobility of the foot and ankle can affect many aspects of life. Some of the symptoms that patients may notice include limited flexibility, where one cannot bend the toes and rotate the foot or walk on a rough surface. Morning stiffness is also experienced commonly, and the patient’s discomfort increases for the first minutes and hours of waking up but subsides as the day goes on.
Instability
The subtalar joint is one of the most significant in maintaining foot stability during its movements. If arthritis develops in this joint, the patient may feel like the ankle is loose or will turn or roll over easily. Such instability may lead to falls and more injuries among elderly patients.
Deformity
Depending on the degree of subtalar arthritis, the joint can become distorted in its most severe form. This may result in noticeable alterations in the contour of the foot as well as the ankle joint. The disease may lead to the development of a flat foot or, on the contrary, increase the height of the arch.
Subtalar Arthrodesis
In cases when conservative management measures do not help in managing the pain and disability resulting from subtalar arthritis, surgery may be required. The common surgical procedure that is recommended for this condition is subtalar arthrodesis.
Subtalar arthrodesis, also referred to as subtalar fusion, is the surgical process in which the talus and calcaneus bones are fused. This process is done to minimise the pain and enhance stability by removing the joint space and letting the bones fuse.
Recovery and Outcomes
Postoperative recovery following the subtalar arthrodesis may take some months. Strength and mobility are critical aspects that are covered by physical therapy. It eliminates the pain because the arthritic joint has been replaced, but it has the adverse effect of limiting the degree of foot movement.
Subtalar Joint Arthritis Exercises
Strength, flexibility, and joint health can be improved by exercising and, therefore, help in controlling the symptoms of subtalar arthritis. Here are some recommended exercises:
Ankle Circles
Ankle circles are one of the most uncomplicated basic exercises that are recommended to ensure that the joints remain flexible. To do this exercise, get into a sitting position with your leg straight and move your ankle clockwise and anticlockwise. Remember to rotate the ankle in circles both clockwise and anticlockwise. It assists in mobilising the joint and increasing the flexibility of the joint space.
Toe Raises
Toe raises help the muscles that surround the subtalar joint, which results in better support. The starting position is the standing position with the feet shoulder-width apart; using your right hand, raise the right toes off the floor but keep the heels in contact with the surface. Keep the position for a few seconds, and then slowly bring the toes back to the starting position. It is suggested that this exercise should be done 10-15 times to start with and gradually increase the repetitions as the muscles get stronger.
Heel Slides
Heel slides are quite useful in increasing the dorsiflexion of the subtalar joint. To execute this exercise, one needs to be seated, and the legs stretched while sliding the heel towards the buttocks, with the foot touching the floor. The hold should be kept for a few seconds, after which the heel is slid back to the initial position. You can perform this exercise 10-15 times on each foot.
Towel Stretch
The towel stretch is a good exercise that requires you to sit down and straighten your leg, wrap the towel around the arch of your foot, take the towel in both your hands, and, while making a stretch for your calf muscles, pull the towel towards you. Sustain the position for 20-30 seconds before letting go of the arm. Perform the stretch 2-3 times on each foot.
Resistance Band Exercises
Exercises using resistance bands are good in strengthening the muscles that stabilise the subtalar joint. Foot exercises can also be done using a resistance band, including dorsiflexion, plantar flexion, inversion and eversion of the foot. Do each exercise 10-15 times, increasing the intensity as the individual gains strength.
Subtalar Arthritis Physiotherapy
Subtalar arthritis may be treated with the help of physiotherapy, and the key aspects of physiotherapy for subtalar arthritis include:
Pain Management
Physiotherapists apply several approaches to deal with pain and inflammation caused by subtalar arthritis. These may include the application of an ice pack to reduce the swelling in the muscles, the application of a heat lamp to ease the stiff muscles, and the application of electrical currents to help relieve pain. Ultrasound therapy can also be applied in tissue repair and inflammation reduction.
Manual Therapy
Manual therapy is the use of the hands in treating the patient to increase joint mobility and decrease rigidity. Techniques such as one to three manual therapies, like joint mobilisations, to mobilise the subtalar joint within a certain range of motion can be used by physiotherapists to assist in the reduction of pain and increase in mobility. Another benefit of soft tissue massage is that it aids in decreasing muscle contraction and increasing the blood flow in the area.
Exercise Prescription
A physiotherapist will prescribe certain exercises that will help strengthen the muscles, flexibility, and balance. These exercises are essential in maintaining joint health and help to reduce further joint damage. The exercise regime may be a combination of stretching, strengthening and low-impact aerobics to boost fitness levels and decrease pressure on the subtalar joint.
Gait Training
Appropriate gait can reduce the pressure that the subtalar joint will be under. A physiotherapist can also explain gait patterns and how these could be changed to minimise pain and increase mobility. This may include addressing any abnormal gait, fitting orthoses or braces, and advising the patient on the kind of shoes to wear to support the foot.
Non-surgical Treatments
Although various surgical procedures can help provide comfort in critical situations, countless patients with subtalar arthritis can treat the issue conservatively. These conservative strategies aim at alleviating pain, enhancing movement and halting or decreasing the rate of arthritis-related disease.
Lifestyle Modifications
Weight control helps relieve pressure on the joints; exercises like swimming or cycling are less likely to cause pain. Daily activities such as running and jumping should be minimised to avoid worsening the joint’s condition.
Diet and Nutrition in the context of the research
The proper intake of food and nutrition is very important in the management of arthritis. Anti-inflammatory diets exist that would help in improving the status of the joints in the human body.
Anti-inflammatory Foods
It is proven that the inclusion of anti-inflammatory foods can assist in the reduction of arthritis symptoms.
Avoiding Inflammatory Foods
Some foods are pro-inflammatory and should not be frequently taken or even avoided at all costs. These include manufactured foods, sweet beverages, red meat, and foods enriched with trans fats. Cutting down on these inflammatory foods is one of the ways to help control arthritis effectively.
Supplements
Several dietary supplements may offer extra value to people suffering from subtalar arthritis. However, it is always necessary to consult a healthcare provider before beginning any new supplements.
The Approach of a Multidisciplinary Model
In many cases, the management of subtalar arthritis may involve the input of different practitioners in various fields of medicine. Treatment is therefore provided by a team of orthopaedic surgeons, rheumatologists, physiotherapists, and podiatrists, depending on the needs of the individual.
Orthopedic Surgeons
Subtalar arthritis falls in the domain of orthopaedic surgery because orthopaedic surgeons are medical doctors who diagnose and treat disorders of the musculoskeletal system.
Rheumatologists
Rheumatologists are trained in the treatment of autoimmune and inflammatory diseases that may cause subtalar arthritis, such as rheumatoid arthritis. They assist in regulating the chronic inflammatory response and properly coordinate the arthritis patients’ treatment.
Physiotherapists
Subtalar arthritis is best managed through exercise prescription, pain control, and joint mobilisations carried out by physiotherapists. They enable the patients to continue using their joints and also minimise the cases that
Podiatrists
A podiatrist has expertise in foot and ankle and can provide orthotics, proper shoes, and non-surgical management of subtalar arthritis. Thus, they collaborate with other healthcare givers to provide holistic client care.
The Future Development of Subtalar Arthritis Management
Recent medical findings in the scientific literature show that there are new approaches to the treatment and management of subtalar arthritis. The areas to explore include biological therapy, minimally invasive procedures and the field of personalised medicine.
Conclusion
MNT study Published Subtalar arthritis can be regarded as a severe issue that affects a patient’s ability to move and overall quality of life. It is essential to know this disease’s causes, signs, and possible treatments, including operations and non-operations.
Surgical fusion of the subtalar joint will be a viable solution for those with severe signs and symptoms along with the specific indications of subtalar joint involvement, while supportive care such as exercises, physiotherapy, and changes in lifestyle will be useful for others in order to avoid the progression of the disorder and improve their quality of life in terms of pain. Subtalar arthritis affects a subgroup of the population and thus requires early diagnosis, proper treatment and management by an interdisciplinary team.
