Subatalar Osteoarthritis

Subtalar arthritis is characterized by pain in the hindfoot that is :

  • Aggravated by standing and walking
  • Worse on uneven ground.
  • Likely to be associated with stiffness when attempting to move the foot from side to side.
  • Pain is commonly just below the level of the inside and outside ankle bones (medial and lateral malleoli)

The most common cause of subtalar arthritis is a previous injury – usually a calcaneal fracture, or abnormal alignment of the heal bone.Surgical procedures

Surgical Procedures:

Subtalar fusion

A fusion of the subtalar joint alleviates pain, but creates stiffness in motion through the subtalar complex. A construct of 2 to 3 screws across the joint compresses the bones to promote union of the talus and calcaneus. This procedure can be treated either open or arthroscopically.

TTC fusion

A TTC fusion involves fusing both the subtalar and ankle joints and is generally performed with a hindfoot nail.

TTC/Subtalar Fusion Surgery (open or arthroscopic)
Post Operative Instructions


  • You will have a splint on your ankle for 2 weeks following surgery
  • At 2 weeks a solid below knee non walking cas will be then worn for 4-6 weeks
  • At 8 weeks, you will be placed in an aircast, still non weightbearing, and a CT scan will be ordered for 10 weeks post op


  • The surgical incision has been closed with sutures
  • Do not get the cast or wound wet for the first two weeks.
  • When showering place a bag over the cast and secure with tape to your leg to avoid the cast and wound getting wet
  • Stitches will be removed at your 2 week appointment
  • After the stitches are removed, you may begin to shower after 2-3 days
  • Do not immerse the foot in water (bath, hot tub, pool) for 6 weeks
  • Do not apply any lotions or creams on the wound for 6 weeks

Weight Bearing:

  • You will be non weight bearing for the first 10-12 weeks while in a splint or cast
  • You will use a mobility device to offload your foot (crutches, walker, stirrup cast)
  • You will begin weight bearing at 10-12 weeks post op depending on wound healing


  • Pain medication should be used regularly for the first 24-48 hours, when required for the first 1 to 2 weeks, followed by Regular Tylenol


  • For right foot surgery you are not permitted to drive until you have completely weaned off the boot
  • For left foot surgery, please contact your insurance company to see if you are permitted to drive
  • Driving is not permitted while on narcotics


  • Four to six weeks off from work is recommended for initial recovery
  • If you are able to get to work safely, and will be seated for the majority of the day, you may return to work four to six weeks after surgery. This is assuming you are not taking narcotic pain mediation.
  • From 2-6 weeks sedentary duties is recommended
  • By 12-16 weeks you can gradually return to full duties
  • If your job is physically demanding, return to full duties is usually possible around 3-6 months post operatively

Follow Up:

  • You will have your first appointment 2 weeks after surgery in the Fracture Clinic
  • Your next appointments will be at 6 weeks, 3 months then 6 months post operatively
  • You will have x-rays taken at these appointments


  • It is normal to experience mild to moderate pain, numbness, or tingling for the first 2 weeks following surgery
  • Please come to the emergency department if you are suffering from severe pain
  • You will get back to most of your activities by 6-12 months
  • Swelling often remains for 6-12 months
  • Residual stiffness is a normal consequence of ankle fracture