Subtalar Joint Arthrography

Abstract

The purpose of this study was to determine the accuracy and the specificity of an optimum technique of posterior talocalcaneal/posterior subtalar (PST) joint arthrography and anesthetic injection in patients with hindfoot pain. Fifty-five PST joints were studied in 55 patients. The posteromedial approach was used in the first 24 patients, followed by an anterolateral approach in 31 patients. The ease of performance, success of confirming PST needle position, and adverse effects were noted. After contrast injection, a combination of 1% lidocaine and 0.5% bupivacaine was injected. Results consisted of 47 arthrographically confirmed PST injections. The posteromedial approach was deemed more difficult; three patients had tendon sheath opacification and four had unwanted anesthesia of the toes. The anterolateral approach was technically easier and no extra-articular structures were visualized or anesthetized. Therefore, PST arthrography with anesthetic injection is optimized with an anterolateral approach.

The posterolateral fluoroscopy-guided injection technique into the posterior subtalar joint: description of the procedure and pilot study on patient outcomes

“…In the posterolateral injection approach the posterior subtalar joint space is projected freely, allowing fast puncture and easy correction of the puncture direction during the forward movement of the needle. A previous study reported that the posteromedial approach to the subtalar joint was deemed more difficult compared to the other approaches [16]. Furthermore, 4 patients out of 24 (17%) injected from posteromedially had unwanted anesthesia of the toes.…”

“…Because of the posterolateral approach, no major nerves or vessels are at risk of being incidentally punctured. Kraus et al [16] reported that the posterolateral injection approach is also more accurate than the anterolateral approach even when imaging guidance is not used. This pilot study of short and medium term outcomes shows that there was a significant reduction in the mean NRS scores at all follow-up time points, particularly at 20-30 min after injection, but that only approximately onethird of patients reported clinically relevant improvement at 1 month on the PGIC scale.…”

“…With the direct posterolateral approach, the joint space is easy to identify without superimposed anatomical structures. To our knowledge, the technical details of this injection approach have not been published previously, although the recent study by Kraus et al [16] on cadaveric specimens superficially appears quite similar. The purpose of this paper is to describe this technique and to report the patient outcomes up to 1 month post-injection from 23 consecutive patients who returned postal questionnaires.…”

“…There are various techniques described in the literature for injecting medication into this joint, including the anterolateral, posteromedial, lateral oblique, and posterolateral approaches [10][11][12][13]15]. Previously the anterolateral approach was claimed to be the best for injecting the posterior subtalar joint [11,16] as this approach appeared to be comparably easy with less chance of contrast leakage or side effects. However, in most of these approaches the joint space is often difficult to visualize with fluoroscopy because of superimposed structures.…”

“…However, in most of these approaches the joint space is often difficult to visualize with fluoroscopy because of superimposed structures. A recent study comparing the anterolateral with a posterolateral subtalar injection approach determined that the posterolateral approach was much more accurate [16]. No imaging guidance was used in that study and it was done on cadaveric feet.…”