Subtalar Arthritis Treatment in Michigan | Subtalar Fusion & Conservative Care

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

Subtalar arthritis — degeneration of the joint between the talus (ankle bone) and the calcaneus (heel bone) — produces deep hindfoot pain that worsens with walking on uneven ground, climbing stairs, and prolonged standing. Unlike ankle arthritis, which affects the main ankle joint, subtalar arthritis specifically limits the inversion and eversion motion of the hindfoot, making walking on uneven surfaces particularly painful. At Balance Foot & Ankle in Southeast Michigan, Dr. Tom Biernacki diagnoses and treats subtalar arthritis with both conservative measures and, when necessary, surgical fusion.

Causes of Subtalar Arthritis

The most common cause of subtalar arthritis is post-traumatic degeneration following a calcaneal fracture — fractures of the heel bone frequently involve the subtalar joint surface, and even well-treated fractures may lead to arthritis over years. Other causes include rheumatoid arthritis and other inflammatory arthropathies, primary osteoarthritis (less common than in the knee or hip but occurs), talocalcaneal coalition (a congenital fusion of the talus and calcaneus causing early joint degeneration), flatfoot deformity with posterior tibial tendon dysfunction (PTTD) placing excessive stress on the subtalar joint, and Charcot neuroarthropathy in diabetic patients.

Diagnosis

Subtalar arthritis is confirmed by weight-bearing foot X-rays showing joint space narrowing, subchondral sclerosis, and osteophyte formation at the posterior subtalar facet. CT scan provides superior detail of the subtalar joint surfaces and is often preferred for surgical planning. A diagnostic subtalar joint injection with local anesthetic — guided by fluoroscopy or ultrasound — that produces significant temporary pain relief strongly confirms the subtalar joint as the pain source and helps distinguish subtalar arthritis from ankle arthritis (which can present similarly) or plantar fasciitis.

Conservative Treatment

Conservative treatment of subtalar arthritis includes activity modification, shoe wear optimization (stiff-soled rocker-bottom shoes reduce subtalar motion during gait), custom-molded ankle-foot orthoses (AFO) or UCBL orthotics that limit subtalar motion, NSAIDs and topical anti-inflammatory agents, and corticosteroid injections directly into the subtalar joint for temporary relief (typically effective for 3–6 months and can be repeated 2–3 times per year). Physical therapy focusing on peroneal and tibialis posterior strengthening and gait modification may help offload the subtalar joint.

Subtalar Fusion Surgery

When conservative measures fail to provide adequate pain relief, subtalar arthrodesis (fusion) is the definitive treatment. The degenerated joint surfaces are prepared by removing remaining cartilage and the talus and calcaneus are held in optimal alignment with large screws or a combination of screws and a staple. The bones heal together over 10–14 weeks, eliminating the arthritic motion and the pain it produces. Subtalar fusion has excellent outcomes for pain relief (85–90% of patients report significant improvement) and preserves most functional walking ability. Loss of inversion/eversion motion is partially compensated by the ankle joint and the Chopart joint complex above. Patients can typically return to reasonable walking activity at 3 months and most daily activities at 4–6 months.

Frequently Asked Questions

Deep hindfoot pain with walking doesn’t have to limit your life. Contact Balance Foot & Ankle to schedule an evaluation with Dr. Biernacki in Southeast Michigan.

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

Get Expert Help at Balance Foot & Ankle

If this condition is affecting your daily activities or hasn’t improved with home treatment, schedule an evaluation with Dr. Tom Biernacki. We offer same-day appointments at our Howell and Bloomfield Hills locations and accept most insurance including Medicare. Most patients are walking comfortably within 4-6 weeks of starting our protocol — conservative care first, surgery only when needed.

Call (248) 337-5500 or request an appointment online. Our team responds within 1 business hour during clinic days.

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?

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.