J Korean Foot Ankle Soc.  2021 Mar;25(1):38-45. 10.14193/jkfas.2021.25.1.38.

Is Subtalar Joint Instability an Important Consideration When Treating Ankle Joint Instability?

Affiliations
  • 1Department of Orthopedic Surgery, Kangdong Sacred Heart Hospital, Seoul, Korea

Abstract

Subtalar joint instability (STI) is one of the causes of persistent hindfoot pain even after treatment for ankle instability. Diagnosis of STI is often neglected because it is a poorly understood concept. However, understanding of the anatomy and injury mechanism of the subtalar joint is a prerequisite of appropriate treatment. Patients with STI usually complain of several symptoms, such as recurrent sprains or a giving way sensation and rolling over. Recently, various diagnostic tools and treatment methods have been investigated. This study was undertaken with the aim of helping clinicians by providing a comprehensive understanding of STI.

Keyword

Ankle; Subtalar; Joint instability; Giving way

Figure

  • Figure. 1 (A) Lateral ligaments (a: ITCL, b: ATCL, c: OTCL, d: bifurcate ligament, e: CFL). (B) Insertion point of 3 components of IER (1: medial, 2: intermediate, 3: lateral). (C) Shows how IER blend with ITCL and OTCL (i: ITCL, ii: OTCL). IER: inferior external retinaculum, ITCL: interosseous talocalcaneal ligament, ATCL: anterior talocalcaneal ligament, OTCL: oblique talocalcaneal ligament, CFL: calcaneofibular ligament.

  • Figure. 2 (A) Telos device standardized stress view of subtalar joint. Foot is internal rotated at 30°, X-ray beam is tilted plantarward 30°. Applied force is limited to 150 N. (B) Clinical example of patient with stable subtalar joint. Parallelism between talus and calcaneal posterior facet can be seen on Broden’s stress view (arrowheads). (C) Clinical example of a patient with chronic subtalar instability, in which a talocalcaneal tilt 25°.

  • Figure. 3 Sagittal T1-weighted magnetic resonance images demonstrate the ruptured cervical ligament (white arrow).

  • Figure. 4 (A) Suture-anchor inserted at lateral calcaneus for repair and augmentation of cervical ligament and inferior external retinaculum. (B) V-shape repair and augmentation of cervical ligament with suture anchor.

  • Figure. 5 (A) Calcaneofibular ligament augmentation via autologous periosteal flap that is mobilized and pedicled at the distal fibula. (B) Anatomic repair including inferior external retinaculum reinforcement.

  • Figure. 6 (A) Extra-anatomic reconstruction using pedicled tendon autograft from peroneus brevis tendon in a modified Elmslie ligamentoplasty. (B) Reconstruction of interosseous talocalcaneal ligament with free hamstrings tendon autograft.

  • Figure. 7 (A) Reconstruction of OTCL, ITCL, and CFL with semitendinosus tendon allograft. (B) Reconstruction of ITCL via pedicled peroneus brevis tendon autograft. OTCL: oblique talocalcaneal ligament, ITCL: interosseous talocalcaneal ligament, CFL: calcaneofibular ligament.


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