Subtalar Arthritis Treatment Michigan | Hindfoot Arthritis Specialist

Medically reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatric Surgeon — Balance Foot & Ankle, Howell & Bloomfield Hills, MI. Last updated April 2026.

Subtalar Arthritis Treatment Michigan

The subtalar joint — located between the talus (ankle bone) and calcaneus (heel bone) — controls side-to-side hindfoot motion, allowing the foot to adapt to uneven terrain. Subtalar arthritis is degeneration of this joint, causing deep hindfoot pain, stiffness, and difficulty walking on uneven surfaces. It is the second most common site of foot and ankle arthritis after the first MTP joint. Dr. Tom Biernacki DPM at Balance Foot & Ankle treats subtalar arthritis in Michigan at our Howell, Brighton, and Bloomfield Hills locations.

Causes of Subtalar Arthritis

• Post-traumatic: Most common — following calcaneus fracture (heel bone fracture), talus fracture, or severe ankle sprain with subtalar damage. Can develop years after the original injury.
• Osteoarthritis: Primary degenerative arthritis, often in older adults
• Inflammatory arthritis: Rheumatoid arthritis, psoriatic arthritis, gout
• Sequelae of flatfoot deformity: PTTD-associated peritalar subluxation accelerates subtalar arthritis
• Avascular necrosis of the talus: After talar neck fracture or steroid use

Symptoms

• Deep, diffuse hindfoot pain — worse on uneven surfaces, hills, and prolonged walking
• Hindfoot stiffness — especially in the morning or after rest
• Pain with inversion and eversion of the foot
• Swelling around the sinus tarsi (the indentation below the lateral malleolus)
• Hindfoot valgus (outward lean of the heel)

Diagnosis

Weight-bearing X-rays in multiple views assess subtalar joint space narrowing, subchondral sclerosis, and calcaneal alignment. CT scan provides the most detailed assessment of subtalar joint architecture and is essential for surgical planning. MRI evaluates bone marrow edema, ligament damage, and peritalar synovitis. Diagnostic subtalar injection (local anesthetic under fluoroscopic or CT guidance) both confirms the joint as the pain source and provides temporary therapeutic relief.

Treatment

Conservative treatment: Ankle foot orthosis (AFO) or custom hindfoot-controlling orthotic reduces subtalar motion during gait. CAM boot immobilization addresses acute flares. Corticosteroid injection under image guidance provides diagnostic confirmation and 3–6 months of pain relief. Activity modification to avoid uneven terrain reduces symptoms.

Subtalar fusion (arthrodesis) is the definitive surgical treatment for end-stage subtalar arthritis that has failed conservative care. The cartilage surfaces of the posterior facet are prepared and the talus and calcaneus are compressed and fixed with two large screws, eliminating the arthritic motion. Recovery: non-weight-bearing × 6 weeks, progressive weight-bearing × 6 weeks, return to activity at 3–6 months. Fusion success rate exceeds 90%; patient satisfaction is high for pain relief.

Frequently Asked Questions

Schedule your subtalar arthritis evaluation at Balance Foot & Ankle in Howell, Brighton, or Bloomfield Hills, Michigan. Dr. Biernacki provides comprehensive hindfoot arthritis care including image-guided injections and surgical fusion.

Most Common Mistake We See

The most common mistake we see is: Waiting too long before seeking care. Fix: any foot pain lasting more than 4 weeks, or any sudden severe symptom, deserves a professional evaluation rather than more rest.

Warning Signs That Need Same-Day Care

Dr. Tom’s Top 3 — The Premium Foot Pain Stack (2026)

If you only buy three things for foot pain, get these. PowerStep + CURREX orthotics correct the underlying foot mechanics, and Dr. Hoy’s pain gel delivers fast topical relief. This is the exact stack Dr. Tom Biernacki, DPM gives his Michigan podiatry patients on visit one — over 10,000 patients have used this exact combination.

In-Office Treatment at Balance Foot & Ankle

If home treatment isn’t providing relief for your arthritis, our podiatry team at Balance Foot & Ankle can help with same-day evaluations and advanced in-office care.

Frequently Asked Questions

When should I see a podiatrist?

See a podiatrist if: foot or ankle pain has lasted more than 2–4 weeks without improvement, you’re changing your gait to avoid pain, you have an open wound or sore that isn’t healing, you notice nail discoloration or thickening, you have diabetes and any foot concern, or pain is severe enough to wake you at night. Most foot conditions are easier and cheaper to treat early — what starts as a minor issue can become a surgical problem with months of delay.

What is the difference between a podiatrist and an orthopedic surgeon?

Podiatrists (DPM — Doctor of Podiatric Medicine) specialize exclusively in the foot, ankle, and lower leg. Orthopedic surgeons (MD/DO) have broader musculoskeletal training but variable foot/ankle subspecialization. For foot and ankle-specific problems, a podiatrist often has more focused training and experience. For injuries involving the leg above the ankle, complex pediatric cases, or multi-level reconstruction, orthopedic consultation may be appropriate. We frequently co-manage patients with orthopedic colleagues.

How do I know if my foot pain is serious?

Signs that warrant same-day or next-day evaluation: severe pain that appeared suddenly without clear cause, swelling, redness, and warmth that appeared suddenly (possible gout, infection, or Charcot fracture), an open wound that looks infected (redness spreading, pus, warmth), inability to bear weight, or any foot problem in a diabetic patient. Pain that’s been present for weeks and is stable is important but not an emergency — schedule within 1–2 weeks.

Can foot problems cause back and knee pain?

Yes — this is a kinetic chain effect. Abnormal foot mechanics (overpronation, supination, leg length discrepancy) cause compensatory changes in knee, hip, and lumbar alignment. Roughly 30% of patients presenting to our clinic with knee pain have a treatable foot-level biomechanical cause. Correcting foot mechanics with orthotics or appropriate footwear often provides significant knee and back relief. If you have chronic knee or back pain and haven’t had your foot mechanics evaluated, it’s worth a consult.

Are orthotics worth it?

For the right conditions, yes — custom orthotics are among the most cost-effective interventions in podiatry. They’re most effective for: plantar fasciitis, flat feet with secondary knee/back pain, leg length discrepancy, metatarsalgia, posterior tibial tendon dysfunction, and diabetic foot pressure management. Quality OTC orthotics ($35–60) resolve symptoms for 60% of patients with mild-to-moderate conditions. Custom orthotics are appropriate when OTC options have failed or when the biomechanical problem is complex. We cast custom orthotics in-office.

How do I choose the right running shoes?

Start with your foot type (flat, neutral, high arch) and running pattern (overpronator, neutral, supinator). Flat feet and overpronators do best in stability or motion-control shoes. Neutral feet do well in neutral-cushioned shoes. High arches need maximum cushioning with flexible soles. Always buy running shoes at the end of the day (foot swelling peaks then), get properly fitted by a specialist, and replace every 300–500 miles. If you’ve been injured repeatedly, a gait analysis can identify the mechanical flaw driving your injury pattern.

What is the difference between a sprain and a fracture?

A sprain is a ligament injury (the tissue connecting bones); a fracture is a break in the bone itself. Both can occur with the same trauma (ankle roll, fall). The old test — ‘if you can walk, it’s not broken’ — is wrong; many fractures are initially weight-bearable. Key differences: a fracture typically produces localized bone tenderness along the bone itself, while a sprain is tender over the ligament. X-ray is the standard to differentiate. High-grade sprains without proper treatment can be as disabling as fractures.

How do I prevent foot and ankle injuries?

The four most impactful prevention strategies: (1) Supportive, appropriately fitted footwear for your foot type and activity. (2) Gradual activity progression — the 10% rule (never increase weekly mileage or intensity by more than 10%). (3) Regular calf and ankle mobility work. (4) Strengthening the posterior tibial tendon, peroneals, and intrinsic foot muscles. Most overuse injuries are preventable; most acute injuries are not — but ankle sprain recurrence (60–70% without rehab) is prevented by balance and proprioception training.