Subtalar Arthroscopy

Subtalar arthroscopy is a minimally invasive surgical technique for evaluation and treatment of the subtalar (talocalcaneal) joint complex. The technique uses small-bore arthroscopes (typically 2.7 mm 30°, sometimes 1.9 mm) introduced through standard portals: anterolateral (lateral to peroneal tendons, dorsal to calcaneocuboid joint), posterolateral (lateral to Achilles, posterior facet access), and accessory portals (middle, anterior accessory) for instrumentation. Distraction with non-invasive devices or pin distractor enhances visualization.

Indications include diagnostic arthroscopy for chronic lateral hindfoot pain, post-traumatic subtalar arthrofibrosis (especially after calcaneal or talar fractures), sinus tarsi syndrome with chronic pain refractory to conservative treatment, intra-articular loose bodies (osteochondritis dissecans, post-traumatic), peroneal tendon disorders requiring concurrent evaluation, talocalcaneal coalition resection (selected non-bony cases), os trigonum syndrome with posterior impingement, arthroscopic subtalar arthrodesis (for isolated subtalar OA), and posterior ankle/subtalar pathology in athletes.

Outcomes show 80-90% good-excellent results for appropriate indications. Arthroscopic subtalar arthrodesis demonstrates fusion rates of 85-95% with shorter healing time, reduced wound complications, and faster return to activities compared to open arthrodesis. Complications (5-10%) include sural nerve injury (most common, posterolateral portal), peroneal tendon injury, infection, and incomplete decompression. Postoperative protocol includes immobilization (varies by procedure), gradual progression to weight-bearing, physical therapy, and return to sport at 3-6 months.