Subtalar Arthritis — Rearfoot Pain & Conservative Treatment Michigan

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

What Is Subtalar Arthritis?

The subtalar joint — the articulation between the talus and calcaneus (heel bone) — is the primary joint responsible for rearfoot inversion and eversion: the side-to-side tilting motion of the hindfoot that allows adaptation to uneven terrain. Subtalar arthritis is cartilage loss at this joint, causing pain with walking on uneven surfaces, during stair descent, with lateral pivoting activities, and eventually with flat ground walking in advanced stages. Unlike ankle (tibiotalar) arthritis which produces pain with dorsiflexion and plantarflexion, subtalar arthritis characteristically produces pain with inversion/eversion — patients describe pain when walking on grass, gravel, slopes, or any surface that requires hindfoot adaptation. At Balance Foot & Ankle in Howell and Bloomfield Hills, Michigan, Dr. Tom Biernacki, DPM evaluates and manages subtalar arthritis. Call (810) 206-1402.

Causes — Post-Traumatic and Primary

Like ankle arthritis, the majority of subtalar arthritis is post-traumatic: calcaneal fractures (intra-articular fractures involving the posterior facet are a leading cause — up to 50% of operatively treated calcaneal fractures develop clinically significant subtalar arthritis within 5–10 years); severe ankle sprains with subtalar component; and talocalcaneal coalition (a congenital fusion of the subtalar bones that abnormally stiffens the joint and accelerates arthritic change). Primary osteoarthritis of the subtalar joint is less common than ankle or knee primary OA. Rheumatoid arthritis and psoriatic arthritis preferentially involve the hindfoot and frequently produce subtalar joint destruction.

Conservative Management

Conservative management of subtalar arthritis focuses on limiting the inversion/eversion motion that causes impingement: a lace-up ankle brace or Arizona-style leather AFO that limits hindfoot motion while allowing forward progression; custom orthotics with a deep heel cup, rearfoot varus or valgus posting depending on hindfoot alignment, and a rigid rearfoot section; rocker-bottom shoe modifications to reduce overall hindfoot motion demand; and activity modification to avoid uneven terrain, pivoting sports, and activities requiring hindfoot adaptation. Corticosteroid injections into the subtalar joint — technically more challenging than ankle injections due to the joint’s anatomy; fluoroscopic or ultrasound guidance improves accuracy. MLS laser therapy for synovitis. Conservative management controls symptoms effectively in mild-moderate disease.

Subtalar Arthrodesis — Surgical Treatment

Subtalar joint fusion (arthrodesis) is the definitive surgical treatment for subtalar arthritis that has failed conservative management. The procedure fuses the talocalcaneal articulation with screws, eliminating the painful motion while preserving ankle (tibiotalar) motion. Outcomes: 80–90% patient satisfaction; ability to walk on flat surfaces without pain; and elimination of uneven-terrain pain. Limitation: subtalar fusion permanently eliminates the hindfoot inversion/eversion, requiring the ankle and midfoot to compensate — patients adapt well on flat surfaces but remain limited on highly uneven terrain. Recovery: 8–10 weeks non-weight-bearing, 4–6 months to full activity. Adjacent joint arthritis at the ankle and calcaneocuboid joints can develop over 15–20 years after subtalar fusion.

Distinguishing Subtalar from Ankle Arthritis

The clinical distinction is important because treatment differs: ankle arthritis pain increases with dorsiflexion (going upstairs, walking uphill, squatting); subtalar arthritis pain increases with inversion/eversion (uneven ground, lateral sports movements, walking on slopes). The Coleman block test and clinical stress tests help isolate each joint. Weight-bearing CT scan is the gold standard for imaging both joints simultaneously — it accurately quantifies cartilage loss in each subtalar facet (posterior, middle, anterior) and guides surgical planning. Standard X-rays underestimate subtalar arthritis severity because the overlapping calcaneal anatomy obscures joint space visualization.

Subtalar Arthritis Management in Howell & Bloomfield Hills Michigan

Dr. Tom Biernacki, DPM provides subtalar arthritis evaluation with clinical testing, weight-bearing X-ray, and CT coordination, along with comprehensive conservative management and surgical consultation at Balance Foot & Ankle. Serving Howell, Brighton, South Lyon, Bloomfield Hills, Troy, Auburn Hills, and all Southeast Michigan. Book your evaluation or call (810) 206-1402.

Subtalar Arthritis Treatment in Michigan

Subtalar arthritis causes deep rearfoot pain that worsens on uneven terrain. Our podiatrists provide conservative management with custom orthotics and bracing, and our surgeons offer subtalar fusion when conservative measures aren’t enough.

Explore Our Rearfoot Treatment Options → | Book Your Appointment | Call (810) 206-1402

Clinical References

1. Easley ME, et al. Isolated subtalar arthrodesis. J Bone Joint Surg Am. 2000;82(5):613-624.
2. Rammelt S, et al. Subtalar arthrodesis after calcaneal fractures. Foot Ankle Clin. 2002;7(1):77-91.
3. Jung HG, et al. Outcomes after subtalar distraction arthrodesis with block bone grafting. Foot Ankle Int. 2010;31(12):1043-1049.

Your Board-Certified Podiatrists

Dr. Tom Biernacki, DPM

Board-Certified · FACFAS

Dr. Carl Jay, DPM

Board-Certified Podiatrist

Dr. Daria Gutkin, DPM

Podiatrist

Dr. Tom Biernacki, DPM

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.