Arthroscopic release for painful subtalar stiffness after intra-articular fractures of the calcaneum

Abstract

We describe the surgical technique and results of arthroscopic subtalar release in 17 patients (17 feet) with painful subtalar stiffness following an intra-articular calcaneal fracture of Sanders' type II or III. The mean duration from injury to arthroscopic release was 11.3 months (6.4 to 36) and the mean follow-up after release was 16.8 months (12 to 25). The patient was positioned laterally and three arthroscopic portals were placed anterolaterally, centrally and posterolaterally. The sinus tarsi and lateral gutter were debrided of fibrous tissue and the posterior talocalcaneal facet was released. In all, six patients were very satisfied, eight were satisfied and three were dissatisfied with their results. The mean American Orthopaedic Foot and Ankle Society ankle-hindfoot score improved from a mean of 49.4 points (35 to 66) pre-operatively to a mean of 79.6 points (51 to 95). All patients reported improvement in movement of the subtalar joint. No complications occurred following operation, but two patients subsequently required subtalar arthrodesis for continuing pain. In the majority of patients a functional improvement in hindfoot function was obtained following arthroscopic release of the subtalar joint for stiffness and pain secondary to Sanders type II and III fractures of the calcaneum.

Simultaneous Use of Lateral Calcaneal Ostectomy and Subtalar Arthroscopic Debridement for Residual Pain After a Calcaneal Fracture

“…Calcaneal fractures account for 60% of all injuries to the tarsal bones and 2% of all fractures (13). Approximately three quarters of calcaneal fractures are intra-articular fractures (15), which have consistently caused disability to the patient (5).…”

“…The AOFAS score after treatment improved from 69.9 to 77.2 points. In another study, Lee et al (13) assessed the use of arthroscopic debridement of the subtalar joint, sinus tarsi, and lateral gutter after subtalar stiffness developed subsequent to calcaneal fracture in patients who had presented without articular incongruity of >2 mm. Their findings demonstrated good clinical outcomes for these patients.…”

“…Many surgeons advocate treating these patients by way of either isolated subtalar arthrodesis and/or isolated lateral wall exostectomy (3,6,10,11). Recently, several studies have reported the use of arthroscopic debridement of subtalar joints to treat late complications after calcaneal fractures (12)(13)(14)(15). Arthroscopic debridement of subtalar joints will improve subtalar movement, reduce chronic subtalar pain, and improve the functional outcome without postoperative morbidity (13).…”

“…Recently, several studies have reported the use of arthroscopic debridement of subtalar joints to treat late complications after calcaneal fractures (12)(13)(14)(15). Arthroscopic debridement of subtalar joints will improve subtalar movement, reduce chronic subtalar pain, and improve the functional outcome without postoperative morbidity (13). However, the lateral wall ostectomy should be considered for some patients with both lateral wall expansion of the calcaneus and a subtalar disorder.…”

“…Each patient presented with all 4 of these conditions. The Japanese Society of Surgery of the Foot hindfoot score (17,18), including related symptoms, subtalar movement (13), and complications, and the numeric pain intensity scale (range 1 to 10, with 10 the "worst pain" before surgery) (19) were assessed preoperatively by 2 of us (I.Y., R.I.), at 1, 3, 6, and 12 months after surgery and then annually until the final follow-up visit. The movement of the subtalar joint was measured as a percentage of the movement on the normal side by 2 of us (I.Y., R.I.).…”