Subtalar arthritis — degeneration of the talocalcaneal joint cartilage producing hindfoot pain, stiffness, and dysfunction — is a common but underdiagnosed cause of chronic hindfoot pain. Because the subtalar joint lies deep beneath the skin and shares the anatomical space of the ankle, subtalar arthritis is often attributed to ankle pathology or tibialis posterior tendinopathy and treated inappropriately. Accurate diagnosis and targeted treatment produce significant pain relief and can delay or eliminate the need for surgical fusion.

Causes and Presentation

Etiology: post-traumatic arthritis following calcaneal fractures (the most common cause — up to 60% of displaced intra-articular calcaneal fractures develop symptomatic subtalar arthritis within 5 years); talar fractures affecting the subtalar joint; severe ankle sprains producing chondral damage; progressive flatfoot deformity (secondary subtalar arthritis from chronic malalignment); inflammatory arthritis (RA, psoriatic arthritis, gout). Clinical features: hindfoot pain with walking on uneven surfaces (the subtalar joint is responsible for terrain accommodation — loss of subtalar motion produces significant functional limitation on uneven ground); morning stiffness; restricted subtalar inversion-eversion (less than 20° total subtalar arc vs. normal 30–40°); point tenderness at the posterior subtalar joint (palpable just inferior and posterior to the lateral malleolus). Diagnostic confirmation: intra-articular diagnostic injection — if fluoroscopy- or ultrasound-guided subtalar injection of local anesthetic eliminates the pain, the subtalar joint is confirmed as the primary pain generator.

Conservative and Surgical Management

Conservative: medially based hindfoot orthotic or UCBL orthotic to limit subtalar motion and reduce loading; Arizona brace (medial upright ankle brace) for more significant pain; intra-articular corticosteroid injection; activity modification. Surgical: isolated subtalar arthrodesis (subtalar fusion) — 4.5mm cannulated screws across the subtalar joint in neutral position (0° valgus); provides reliable pain relief with sacrifice of subtalar motion; gait adapts well with preserved midtarsal mobility; recovery: 6 weeks non-weight-bearing, then progressive weight-bearing in boot to 3 months; return to activity at 4–6 months. Dr. Biernacki at Balance Foot & Ankle performs diagnostic subtalar injections and subtalar arthrodesis for end-stage subtalar arthritis. Call (810) 206-1402 at our Bloomfield Hills or Howell office.

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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 personalized treatment plan. 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 Township offices.

Book Online or call (810) 206-1402

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

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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.