Medically reviewed by Dr. Tom Biernacki, DPM
Board-certified podiatric surgeon | Balance Foot & Ankle, Howell & Bloomfield Hills, MI
Last reviewed: May 2026
Balance Foot & Ankle offers same-day appointments for urgent foot and ankle conditions across Southeast Michigan — but the most important factor in outcomes isn’t getting seen quickly. Our podiatrists explain what to do in the first 24-48 hours before your appointment that most patients skip entirely. Call (810) 206-1402 — expert podiatric care across Michigan.
| Cause | Mechanism | Associated Findings | Prevalence in Subtalar OA |
|---|---|---|---|
| Post-Traumatic (calcaneus fracture) | Intra-articular calcaneal fracture → posterior facet destruction | Subtalar arthrosis within 5–10 years of fracture; peroneal impingement | Most common (~50%) |
| Post-Traumatic (talus fracture / AVN) | Talar neck or body fracture → subtalar joint arthrosis; AVN | Loss of talar height; subtalar and ankle OA combined | ~20% |
| Inflammatory Arthritis (RA, PsA) | Synovitis → cartilage erosion; pannus formation | Bilateral involvement; hindfoot valgus; ankle involvement | ~15% |
| End-Stage PTTD (Stage III) | Uncorrected flatfoot → subtalar cartilage destruction | Rigid flatfoot; sinus tarsi impingement; calcaneal valgus | ~10% |
| Primary (Idiopathic) | Age-related wear; no prior trauma or identified cause | Unilateral; sinus tarsi pain; stiffness | ~5% |
| Treatment | Stage / Indication | Details | Outcomes |
|---|---|---|---|
| Activity Modification + Shoe Modification | Mild subtalar OA; initial treatment | Rocker-sole shoes; stiff shanks; cushioning; avoid uneven terrain | Symptomatic relief; does not halt progression |
| Custom Orthotics / Arizona AFO | Mild-moderate OA with hindfoot deformity | Lateral wedge for valgus; medial wedge for varus; Arizona AFO for moderate OA | Controls alignment; reduces joint loading; may delay surgery years |
| Corticosteroid Injection (subtalar) | Acute flares; moderate OA with synovitis | Fluoroscopic or US-guided posterior approach; sinus tarsi injection | 65–75% significant relief lasting weeks to months; diagnostic value |
| Viscosupplementation (HA injection) | Moderate subtalar OA; steroid intolerance | Off-label for subtalar (FDA approved for knee); single or 3-injection series | Some evidence for pain reduction; less robust than knee data |
| Subtalar Arthrodesis (Fusion) | Failed conservative care 6+ months; severe OA; rigid deformity | Percutaneous or open; 1–2 screws through posterior facet; correct alignment | 85–90% pain relief; 8–10 weeks NWB; adjacent joint arthritis risk at 10–20 years |
| Triple Arthrodesis | Subtalar + talonavicular + calcaneocuboid OA; severe deformity (Stage III PTTD) | Fuse all 3 hindfoot joints simultaneously; powerful deformity correction | High patient satisfaction for pain; significant loss of hindfoot motion; 10–12 weeks NWB |
You are in the right place. Dr. Tom Biernacki, DPM, FACFAS — board-certified foot & ankle surgeon with 3,000+ surgeries — explains exactly what subtalar and hindfoot arthritis means and what works. Call (810) 206-1402 for same-day appointment at Howell or Bloomfield Hills.
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Medically Reviewed | Dr. Tom Biernacki, DPM | Board-Certified Podiatric Surgeon | Balance Foot & Ankle, Michigan
Quick Answer:
Quick Answer: Subtalar arthritis is degeneration of the subtalar joint — the joint below the ankle between the talus (ankle bone) and calcaneus (heel bone) — responsible for side-to-side foot motion. It most commonly follows calcaneus fractures (post-traumatic arthritis) or develops alongside flatfoot deformity, rheumatoid arthritis, or primary osteoarthritis. Symptoms include deep hindfoot aching, difficulty walking on uneven ground, pain with inversion/eversion, and progressive stiffness. Non-surgical management includes bracing, custom orthotics, activity modification, and ultrasound-guided injections. Surgical treatment is subtalar fusion (arthrodesis), which reliably relieves pain with high satisfaction rates.
Pain deep in the hindfoot that worsens on gravel paths, grass, uneven sidewalks, and slopes — but often improves on flat, smooth surfaces — has a specific anatomic explanation: the subtalar joint. This often-overlooked joint lives just below the ankle and handles the complex side-to-side motion your foot needs to adapt to variable terrain. When it degenerates, everyday walking becomes an exercise in pain management.
At Balance Foot & Ankle PLLC, Dr. Tom Biernacki diagnoses and manages subtalar arthritis at our Howell and Brighton Michigan clinics, using diagnostic ultrasound, weight-bearing CT evaluation, and a comprehensive approach from bracing and injections through surgical fusion referral.
Understanding the Subtalar Joint
The subtalar joint is a complex joint formed by three facets where the talus articulates with the calcaneus. Its primary motion is pronation and supination — the rolling inward and outward of the foot during gait that allows you to walk on uneven ground without falling. The joint is supported by the interosseous talocalcaneal ligament, the calcaneofibular ligament, and the medial and lateral talocalcaneal ligaments. It works in concert with the ankle and transverse tarsal joints to create smooth, adaptive gait.
Unlike the ankle joint (tibiotalar joint), the subtalar joint is not easily palpated or visualized clinically — which is why subtalar arthritis is frequently missed or mistaken for chronic ankle pain. The key diagnostic clue is pain specifically provoked by subtalar stress testing (inversion/eversion stress), not by ankle dorsiflexion and plantarflexion testing.
Causes of Subtalar Arthritis
Post-traumatic arthritis is the most common cause, typically following a calcaneus (heel bone) fracture. Even with excellent fracture reduction and fixation, the articular cartilage of the subtalar joint is damaged by the original injury force, and arthritis develops within 5–15 years in the majority of patients who sustain intra-articular calcaneus fractures. This is why subtalar fusion is frequently discussed at the time of initial calcaneus fracture management as a potential future procedure.
Other causes include adult acquired flatfoot deformity (PTTD), which dramatically alters subtalar joint mechanics and loading; rheumatoid arthritis and other inflammatory arthropathies that erode cartilage; primary osteoarthritis (less common than at the ankle or knee); tarsal coalition that has been managed non-surgically for years; and gout or pseudogout crystal deposition.
Symptoms
The classic symptom pattern of subtalar arthritis includes: deep hindfoot pain localized below (not within) the ankle; marked pain on uneven ground that improves on flat surfaces; morning stiffness lasting 20–45 minutes; progressive loss of inversion and eversion range of motion; and aching pain with prolonged standing or walking that is relieved by rest. Many patients describe a sensation of “every rock going right through my heel” on outdoor terrain.
Diagnosis
Dr. Biernacki evaluates subtalar arthritis with a combination of physical examination (subtalar stress testing, Coleman block test for hindfoot alignment, gait analysis), weight-bearing radiographs (AP, lateral, and hindfoot alignment views), and advanced imaging. Weight-bearing CT (WBCT) of the hindfoot is the gold standard for visualizing subtalar joint space narrowing, subchondral sclerosis, and osteophytes in the functional, loaded position. Standard MRI is useful for evaluating associated soft tissue pathology and early cartilage loss.
Diagnostic injection of local anesthetic into the subtalar joint under ultrasound or fluoroscopic guidance is the most reliable way to confirm the subtalar joint is the dominant pain source before committing to surgical management.
Non-Surgical Treatment
Custom Orthotics and Bracing
A custom orthotic with a deep heel cup and medial or lateral posting controls subtalar motion and reduces painful joint loading. For more significant arthritis, an ankle-foot orthosis (AFO) or a lace-up ankle brace with rigid lateral strapping further limits subtalar motion during activity. Arizona-style leather AFOs are particularly well-tolerated by subtalar arthritis patients for daily activity.
Activity Modification and Footwear
Avoiding uneven terrain, switching from trail running to pool running or cycling, and wearing supportive footwear with a firm midsole and substantial heel counter all reduce pain. A rocker-bottom sole modification (available from a pedorthist or specialty shoe store) can further reduce hindfoot joint stress during the push-off phase of gait.
Ultrasound-Guided Corticosteroid Injection
The subtalar joint is a technically challenging joint to inject accurately without imaging — it sits deep to multiple tendons and has a complex three-facet geometry. Ultrasound or fluoroscopic guidance is strongly preferred. An accurately placed cortisone injection can provide 3–6 months of meaningful pain relief and is both diagnostic (confirming the joint as the pain generator) and therapeutic.
Platelet-Rich Plasma (PRP)
PRP injections into the subtalar joint are an emerging option for patients seeking alternatives to cortisone or who have had diminishing returns from repeated steroid injections. The evidence base for PRP in small joint arthritis is growing, with several studies showing 6–18 month pain relief comparable to or superior to corticosteroid at longer follow-up intervals.
Surgical Treatment: Subtalar Fusion (Arthrodesis)
Subtalar arthrodesis is one of the most reliable procedures in foot and ankle surgery, with patient satisfaction rates of 80–90% in appropriately selected patients. The procedure eliminates subtalar joint motion by fusing the talus and calcaneus together with screws — trading the painful arthritic joint for a stable, pain-free hindfoot. Because the ankle, midfoot, and forefoot maintain their motion, most patients walk with a near-normal gait pattern after fusion, with slightly reduced ability to walk on sharply uneven terrain.
Recovery involves non-weight-bearing for 6–8 weeks, progressive protected weight-bearing in a walking boot at 8–12 weeks, and return to normal shoes at 3–4 months. Full activity recovery averages 6 months. Hardware removal for symptomatic screws is occasionally needed at 12–18 months post-fusion.
Subtalar Arthritis Care in Michigan
Balance Foot & Ankle PLLC offers comprehensive subtalar arthritis evaluation and non-surgical management in Livingston County. Dr. Biernacki coordinates surgical referrals with orthopedic foot and ankle surgeons when fusion is indicated, ensuring continuity of care from diagnosis through recovery. Patients from Howell, Brighton, Hartland, Fowlerville, and surrounding communities receive the same quality of evaluation available at academic medical centers — without the waiting lists.
Dr. Tom's Product Recommendations
PowerStep Pinnacle Premium Insoles
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High-density foam with a deep heel cup and rigid stabilizer cap — excellent for controlling subtalar pronation and reducing painful hindfoot joint loading. Often used as an interim measure while custom orthotics are fabricated.
Dr. Tom says: “”My podiatrist recommended these for my hindfoot arthritis while I waited for my custom orthotics. Noticeably less pain on my lunch walks.””
Best for: Subtalar motion control, hindfoot arthritis daily footwear management
Not ideal for: Low-volume shoes or patients needing custom posting
Disclosure: We earn a commission at no extra cost to you.
Lace-Up Ankle Stabilizer — Mueller Hg80
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Semi-rigid lace-up ankle brace with figure-8 strapping that limits subtalar inversion and eversion. Provides meaningful motion restriction for patients with moderate subtalar arthritis during walking and outdoor activities.
Dr. Tom says: “”I wear this brace every time I walk on uneven ground — it makes a huge difference in how much pain I have afterward.””
Best for: Moderate subtalar arthritis with uneven terrain pain, activity-specific bracing
Not ideal for: Severe arthritis requiring full rigid AFO support
Disclosure: We earn a commission at no extra cost to you.
Doctor Hoy’s Natural Pain Relief Gel — Foot & Leg
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Topical arnica and menthol gel applied directly to the hindfoot and lateral ankle region to reduce surface inflammation and provide cooling relief after activity. Useful adjunct between injection cycles for subtalar arthritis management.
Dr. Tom says: “”I apply this to my heel and ankle every evening after my walk — it takes the burning soreness down significantly overnight.””
Best for: Daily topical pain relief for hindfoot arthritis and ankle soreness
Not ideal for: Open wounds or acute surgical recovery
Disclosure: We earn a commission at no extra cost to you.
✅ Pros / Benefits
- Diagnostic injection with local anesthetic definitively confirms the subtalar joint as pain source before surgery
- Subtalar fusion has 80–90% patient satisfaction and allows near-normal walking gait
- Non-surgical options (orthotics, bracing, injections) provide meaningful relief for mild-moderate arthritis
❌ Cons / Risks
- Post-traumatic subtalar arthritis is common after calcaneus fractures and often progressive despite conservative care
- Subtalar joint injections require imaging guidance (ultrasound or fluoroscopy) — blind injections miss the joint frequently
- Fusion eliminates subtalar motion permanently — some terrain adaptability is lost
Dr. Tom Biernacki’s Recommendation
Subtalar arthritis is one of the most under-diagnosed causes of chronic hindfoot pain I see in my practice. Patients often come in labeled with ‘chronic ankle pain’ or ‘plantar fasciitis’ and have been treated for months or years without improvement — because nobody has actually stressed the subtalar joint on exam or considered it on imaging. When I test inversion and eversion stress and watch the patient wince, that’s the subtalar joint. We confirm it with a diagnostic injection under ultrasound guidance, then build a management plan from there. The good news: subtalar fusion is one of the most reliable operations in foot and ankle surgery when conservative care fails — patients tell me they wish they’d done it sooner.
— Dr. Tom Biernacki, DPM | Board-Certified Podiatric Surgeon | Balance Foot & Ankle
Frequently Asked Questions
What is the difference between ankle arthritis and subtalar arthritis?
Ankle (tibiotalar) arthritis affects the joint between the tibia and talus — responsible for up-and-down foot motion. Subtalar arthritis affects the joint between the talus and calcaneus — responsible for side-to-side motion. They often coexist but can occur independently. Ankle arthritis pain is typically worse on stairs and inclines; subtalar arthritis pain is typically worse on uneven ground. Both can be confirmed with diagnostic injections.
How long can you manage subtalar arthritis without surgery?
Many patients manage subtalar arthritis non-surgically for years with the right combination of orthotics, bracing, activity modification, and periodic injections. The decision for fusion is driven by pain severity and functional limitation — not by X-ray findings alone. Some patients with advanced radiographic arthritis have manageable pain with conservative care; others with moderate arthritis have severe functional limitation. The fusion conversation begins when quality of life is significantly impacted despite maximal conservative treatment.
Will subtalar fusion affect my ability to walk normally?
Most patients walk with a near-normal gait after subtalar fusion. The ankle, midfoot, and forefoot compensate for the lost subtalar motion. Patients notice reduced ability to walk comfortably on sharply uneven terrain (trail hiking, unstable surfaces), but flat-ground walking, stairs, and daily activities are generally well-tolerated. Athletic function varies — most patients return to walking, cycling, and swimming without difficulty; running and cutting sports are more variable.
Can you inject the subtalar joint in the office?
Yes, but imaging guidance is important for accuracy. The subtalar joint sits beneath the ankle and between tendon structures, making it difficult to enter accurately by palpation alone. Studies show unguided subtalar injections miss the joint in 30–50% of attempts. Dr. Biernacki uses ultrasound guidance for all subtalar injections to ensure accurate placement, maximize therapeutic effect, and confirm the joint is the pain source.
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Frequently Asked Questions
When should I see a podiatrist?
If symptoms persist past 2 weeks, affect your normal activity, or are accompanied by red-flag symptoms (warmth, redness, swelling, inability to bear weight).
What does treatment cost?
Most diagnostic visits and conservative treatments are covered by Medicare and major insurers. Out-of-pocket costs vary by your specific plan.
How quickly can I get an appointment?
Most non-urgent cases see us within 5 business days. Urgent cases (sudden pain, possible fracture) typically same or next business day.
Ready to fix this for good?
Reading goes so far. The fastest path is a 30-minute office visit. Same-day Howell or Bloomfield Hills. Call (810) 206-1402.
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OrthoInfo – AAOS: Arthritis of the Foot and Ankle
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Dr. Tom Biernacki, DPM is a double board-certified podiatrist and foot & ankle surgeon at Balance Foot & Ankle Specialists in Southeast Michigan. With over a decade of clinical experience, he specializes in heel pain, bunions, diabetic foot care, sports injuries, and minimally invasive surgery. Dr. Biernacki is a member of the APMA and ACFAS, and his patient education content on MichiganFootDoctors.com and YouTube has reached over one million views.
Frequently Asked Questions
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- Plantar Fasciitis: Diagnosis and Conservative Management (PubMed)
- Plantar Fasciitis (APMA)
- Diagnosis and Treatment of Plantar Fasciitis (PubMed / AAFP)
- Heel Pain (APMA)
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