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

Subtalar Arthritis: Hindfoot Pain Below the Ankle

Subtalar arthritis is often overlooked because it causes pain in a location that’s easily confused with ankle arthritis, plantar fasciitis, or Achilles tendonitis. The subtalar joint — the joint between the talus (ankle bone) and the calcaneus (heel bone) — is responsible for the side-to-side rocking motion of the hindfoot, and when its cartilage degenerates, the resulting pain can be disabling.

What Is the Subtalar Joint?

The subtalar (talocalcaneal) joint is actually a complex of three articulations between the talus and calcaneus. It allows inversion and eversion — the tilting of the heel inward and outward — which is essential for walking on uneven terrain, running, and absorbing ground reaction forces. It works in concert with the ankle joint, and pathology in either can affect the other.

Causes of Subtalar Arthritis

• Post-traumatic: Most common cause — calcaneal fractures (especially intra-articular) and severe ankle sprains frequently lead to subtalar arthritis years later. If you’ve had a significant hindfoot injury, subtalar arthritis is a expected long-term consequence.
• Inflammatory arthritis: Rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis all affect the subtalar joint
• Gout and CPPD: Crystal deposition arthropathy
• Primary osteoarthritis: Less common than post-traumatic; develops from years of mechanical wear
• Osteochondral lesion extension: Talar osteochondral lesions can involve the subtalar joint
• Tarsal coalition: When treated with resection, subtalar arthritis can develop years later

Symptoms

• Deep hindfoot pain — diffuse around the heel, not localized to the plantar heel (which would suggest plantar fasciitis) or posterior (Achilles)
• Pain worse on uneven terrain, stairs, and trail walking
• Stiffness in the hindfoot — difficulty with side-to-side motion
• Swelling around the sinus tarsi (the outer side of the heel, below the lateral malleolus)
• Pain may radiate to the outer ankle or foot
• Often described as a “grinding” sensation in the heel with inversion/eversion

Diagnosis

Subtalar arthritis can be difficult to assess clinically because the joint is deep and hard to isolate on physical exam:

• Subtalar stress test: Passive inversion/eversion at the hindfoot — pain with subtalar motion (as opposed to ankle dorsi/plantarflexion) points to subtalar pathology
• Weight-bearing X-rays: AP, lateral, and calcaneal axial views; may show joint space narrowing, subchondral sclerosis, or cysts in advanced disease; early disease is often not visible on X-ray
• CT scan: Superior to X-ray for subtalar joint assessment; shows joint space and bone detail clearly
• MRI: Shows cartilage, bone marrow edema, and soft tissue; useful for early-moderate disease
• Diagnostic injection: Fluoroscopy or ultrasound-guided subtalar joint injection with local anesthetic — if the patient is significantly improved for 4–6 hours, the subtalar joint is confirmed as the pain source

Treatment

Conservative Management

• Custom orthotics: Rigid or semi-rigid devices that limit subtalar motion; lateral wedging or medial support depending on hindfoot alignment; reduces pain significantly in many patients
• Lace-up ankle brace or Arizona brace: Controls hindfoot motion; reduces joint loading
• Activity modification: Avoid uneven terrain; switch to flat, predictable surfaces; pool walking reduces joint load dramatically
• NSAIDs or topical anti-inflammatories
• Corticosteroid injection: Subtalar joint injection; typically 3–6 months of relief; repeatable
• PRP or hyaluronic acid injection: Emerging evidence for longer-lasting relief

Surgical Treatment: Subtalar Arthrodesis (Fusion)

When conservative measures fail to provide acceptable quality of life, subtalar fusion is the definitive treatment. The cartilage is removed and the talus and calcaneus are fused together with screws. The joint no longer moves — but pain is eliminated in ~85–90% of cases.

• Recovery: 6–8 weeks non-weight-bearing, then progressive weight-bearing over 3 months
• Return to full activity: 6–12 months
• Gait adaptation: Adjacent joints (ankle, midfoot) compensate for subtalar motion loss; patients generally adapt well
• Adjacent joint arthritis: A long-term concern — adjacent joints see increased stress after subtalar fusion

Ready to Get Relief? We’re Here to Help.

Board-certified podiatrists Dr. Tom Biernacki, Dr. Carl Jay, and Dr. Daria Gutkin see patients daily at our Howell and Bloomfield Township, MI offices.

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Subtalar joint arthritis causes deep hindfoot pain and stiffness. Our podiatrists offer comprehensive treatment from conservative management to surgical fusion when needed.

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Clinical References

1. Easley ME, et al. Isolated subtalar arthrodesis. J Am Acad Orthop Surg. 2000;8(4):227-236.
2. Arangio GA, et al. Subtalar joint arthritis. Orthop Clin North Am. 2004;35(1):143-151.
3. Chou LB, et al. Subtalar arthrodesis: current concepts. Foot Ankle Clin. 2019;24(4):589-603.

Dr. Tom Biernacki, DPM

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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.