Subtalar Arthroereisis: Sinus Tarsi Implant for Flexible

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

Subtalar arthroereisis — the placement of a sinus tarsi implant to limit excessive subtalar joint pronation in flexible flatfoot — is a minimally invasive surgical technique that has gained widespread use in pediatric and adolescent flatfoot surgery over the past two decades. Understanding which patients benefit from arthroereisis, how the procedure works, and what outcomes to realistically expect is important for parents and patients considering this option.

Mechanism and Indications

A cylindrical or conical implant is inserted into the sinus tarsi (the lateral canal between the talus and calcaneus) under fluoroscopic guidance through a small lateral incision. The implant mechanically limits excessive pronation motion at the subtalar joint by blocking the anterior facet from the posterior calcaneus — functioning as a “speed bump” that prevents end-range subtalar eversion. Arthroereisis is indicated for symptomatic flexible flatfoot (activity-limiting pain, fatigue, shoe wear difficulty, gait deviation) in skeletally immature patients who have failed conservative management with custom orthotics and physical therapy. The pediatric age window of 8–14 years is typically preferred — the foot has matured enough to predictably accommodate the implant but the growing skeleton allows some correction to be maintained after implant removal if needed.

Advantages Over Calcaneal Osteotomy

Arthroereisis offers significant advantages for appropriate pediatric patients: the procedure is reversible (implant removal is a simple outpatient procedure if symptomatic), it avoids cutting bone, recovery is faster than osteotomy (walking in a surgical boot within 1–2 weeks versus 6 weeks for calcaneal osteotomy), and it can be combined with gastrocnemius recession for concurrent Achilles tightness correction. The disadvantage is that arthroereisis does not provide the degree of alignment correction achievable with calcaneal osteotomy — for severe deformities, osteotomy produces better alignment correction.

Outcomes and Implant Removal

Published studies report 70–85% good or excellent outcomes with sinus tarsi arthroereisis for appropriately selected flexible flatfoot in children. Implant-related pain requiring removal occurs in approximately 10–20% of cases — most commonly from oversized implant selection or progressive sinus tarsi irritation. Implant removal reliably resolves sinus tarsi pain, and significant deformity recurrence after removal is uncommon in patients who achieved skeletal maturity with the implant in place. Dr. Biernacki at Balance Foot & Ankle evaluates pediatric flatfoot and discusses all surgical options — arthroereisis, calcaneal osteotomy, and conservative management — based on the individual patient’s deformity, age, and activity goals. Call (810) 206-1402 at our Bloomfield Hills or Howell office.

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In-Office Treatment at Balance Foot & Ankle

If home care isn’t resolving your your foot or ankle concern, a visit with a board-certified podiatrist is the fastest path to accurate diagnosis and a personalized plan. At Balance Foot & Ankle Specialists, Dr. Tom Biernacki, Dr. Carl Jay, and Dr. Daria Gutkin offer same-day and next-day appointments at both our Howell and Bloomfield Hills offices. We perform on-site diagnostic ultrasound, digital X-ray, conservative care, advanced regenerative treatments, and minimally invasive surgery when indicated.

Call (810) 206-1402 or request an appointment online. Most insurance plans accepted, including Medicare, Blue Cross Blue Shield, Aetna, Cigna, and United Healthcare.

Frequently Asked Questions

When should I see a podiatrist?

See a podiatrist for any foot or ankle pain that persists more than 2 weeks, doesn’t improve with rest, limits your daily activities, or is accompanied by swelling, numbness, or skin changes. People with diabetes or circulation problems should see a podiatrist regularly even without symptoms.

What does a podiatrist treat?

Podiatrists diagnose and treat all conditions of the foot, ankle, and lower leg including plantar fasciitis, bunions, hammertoes, toenail problems, heel pain, nerve pain, diabetic foot care, sports injuries, fractures, and foot deformities — both surgically and non-surgically.

What can I expect at my first podiatry visit?

Your first visit includes a full medical history, physical examination of your feet and gait, and in-office diagnostic imaging if needed (X-rays, ultrasound). We’ll discuss your diagnosis and create a plan tailored to your foot type. Most visits take 30–45 minutes.

Need Treatment at Balance Foot & Ankle?

Dr. Tom Biernacki, Dr. Carl Jay, and Dr. Daria Gutkin see patients at our Howell and Bloomfield Hills offices.

Book Online or call (810) 206-1402

Differential Diagnosis: What Else Could It Be?

Several conditions share symptoms with Flat Feet (Pes Planus) and are commonly misdiagnosed in the first office visit. Considering these alternatives is part of every Balance Foot & Ankle exam:

• Posterior tibial tendon dysfunction (PTTD). Acquired adult flatfoot with single-leg heel-rise weakness.
• Tarsal coalition. Rigid flatfoot in an adolescent — bone bridge between hindfoot bones.
• Charcot foot (diabetic). Sudden warm, swollen, collapsing midfoot in a diabetic — urgent off-loading.

If your symptoms don’t fit the textbook pattern, ask your podiatrist which differentials they ruled out — that conversation often shortcuts months of trial-and-error treatment.

Most Common Mistake We See

The most common mistake we see is: Buying motion-control shoes without a gait assessment. Fix: get a pressure-plate analysis or wet-foot test first to confirm overpronation and arch height.

Warning Signs That Need Same-Day 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.

Related Care at Balance Foot & Ankle

Clinical flat services at our Howell and Bloomfield Hills offices.

Flat Feet TreatmentFlatfoot ReconstructionCustom Orthotics