What is the Subtalar Fusion Procedure?
Subtalar fusion is a surgical procedure that joins, or “fuses,” the bones in the subtalar joint, located below the ankle joint between the talus and calcaneus (heel bone). The subtalar joint allows for side-to-side movement of the foot, especially on uneven surfaces.
Subtalar fusion is typically recommended when this joint becomes a source of chronic pain, usually due to:
- Arthritis (from wear-and-tear, trauma, or autoimmune disease)
- Post-traumatic injury
- Severe deformity or instability
- Failed prior surgeries
By eliminating movement in the subtalar joint, fusion relieves pain and improves foot stability.
Preparation for Subtalar Fusion
Preoperative Steps:
- A thorough physical examination and review of symptoms
- Imaging, such as X-rays, CT scans, or MRI, to evaluate joint damage
- Assessment of medical history, medications, and bone health
- Discussion of risks, recovery expectations, and alternative treatments
Patients are usually advised to:
- Stop smoking, as it impairs bone healing
- Avoid certain medications (e.g., blood thinners)
- Plan for non-weight bearing mobility post-surgery, including crutches, walker, or a knee scooter
About the Fusion
The Procedure:
- Performed under general or regional anesthesia
- A small incision is made on the outer side of the foot
- The damaged cartilage is removed from the joint surfaces
- The talus and calcaneus bones are then compressed together
- Screws or hardware are used to hold the bones in place and promote fusion
- In some cases, bone grafting may be needed to stimulate healing
The goal is for the bones to grow together into a single solid unit, eliminating painful motion.
Aftercare and Recovery from Subtalar Fusion
Immediate Aftercare:
- The foot is placed in a splint or cast
- Patients are typically non-weight bearing for 6–8 weeks
- Pain is managed with medication and elevation
Long-Term Recovery:
- Follow-up imaging to monitor healing progress
- Transition to a walking boot after initial healing
- Physical therapy may be recommended for gait training and overall mobility
- Most patients can resume normal walking within 3–6 months
Full fusion of the joint typically occurs within 3 to 6 months, although full recovery may take up to a year, depending on individual healing and overall health.
FAQs
Bone fusion generally takes 3 to 6 months, but full recovery—including return to walking and daily activities—may take up to 12 months, especially in complex cases.
Pain levels vary, but most patients experience significant pain relief once the joint is fused. Postoperative discomfort is common but manageable with medication and typically decreases after the first few weeks.
The procedure has a high success rate, with about 85–95% of patients reporting significant pain reduction and improved stability. Success depends on proper healing, patient compliance, and overall health.
Running is generally not recommended after subtalar fusion due to the loss of motion in the joint. However, most patients can walk comfortably, hike, bike, and swim without difficulty.
Diagnosis involves:
– A physical exam for joint tenderness and mobility
– X-rays to assess joint space and bone alignment
– CT or MRI to view joint damage or arthritis in detail
– Patient history of pain, stiffness, or instability
Risks include nonunion (failure of bones to fuse), infection, nerve damage, hardware irritation, and prolonged stiffness or altered gait. Smoking, poor bone quality, and certain medical conditions can increase complication risk.
You’ll lose side-to-side motion in the foot, but most patients adapt well. Over time, surrounding joints compensate, and walking on flat surfaces feels normal or near-normal. Walking on uneven terrain may feel different or slightly limited.
