Hindfoot arthritis affects the joints below the ankle, mainly the subtalar and talonavicular joints, causing deep aching pain and difficulty on uneven ground. It is often the legacy of an old heel or talus fracture. Many are managed with orthotics and injections; when these fail, a hindfoot fusion gives durable relief.
Symptoms
- Deep aching pain below the ankle and around the heel
- Worse on uneven ground and slopes, easier on the flat
- Morning stiffness
- A progressive flatfoot in late disease
Causes & risk factors
- Mostly post-traumatic, especially after a calcaneal fracture from a fall from height
- A fixed adult acquired flatfoot
- Rheumatoid arthritis
- Primary osteoarthritis
Conservative treatment comes first
- Supportive footwear
- A custom AFO for advanced disease
- A rocker sole
- Activity modification
- An image-guided steroid injection into the subtalar joint — also used diagnostically to confirm the pain source
When surgery is considered
An isolated subtalar fusion is used where arthritis is confined, preserving ankle and forefoot movement. A triple fusion (subtalar, talonavicular, calcaneocuboid) is used for more widespread disease. Minimally invasive where suitable — protected for 6–10 weeks, full recovery 6–12 months. Ankle movement is preserved.
Questions & answers
No. A subtalar or triple fusion stiffens the hindfoot but the ankle still moves, so walking on the flat stays comfortable.
If local anaesthetic placed into the joint relieves your pain, it confirms that joint is the source and predicts that fusing it will help.
Often yes for a long time, with orthotics, footwear and injections. Surgery is for when those stop working.
Sources & further reading
- OrthoInfo (AAOS) — arthritis of foot and ankle
- BOFAS patient information
