Subtalar Fusion

What is subtalar fusion?

Subtalar fusion is surgery that permanently joins the bones in your subtalar joint together. It’s a type of joint fusion (arthrodesis). Healthcare providers sometimes call it subtalar arthrodesis.

A joint is any place in your body where two bones meet. The subtalar joint connects two bones in your foot. It’s where your ankle bone (talus) meets your heel bone (calcaneus). You have one subtalar joint in each foot. They’re just below your ankle joint. Your subtalar joints help you move and keep your balance by letting your foot tilt in toward and out away from the center of your body.

Surgeons most commonly use subtalar fusion to treat severe foot arthritis. Your bones will rub against each other if arthritis has worn away the cartilage that cushions and lubricates your subtalar joint. This can damage your joint and become extremely painful over time. Your surgeon will fuse the bones in your subtalar joint together to become one bone. This fusion will reduce the extra friction inside your foot and relieve the pain.

A healthcare provider will usually suggest subtalar fusion after other, nonsurgical treatments haven’t worked for you. Fusion can relieve severe pain, stiffness and other symptoms that make it hard to move and use your foot.

What happens before subtalar fusion?

You’ll meet with your provider and surgeon before a subtalar fusion. They’ll ask about how the symptoms you’re experiencing affect your daily routine and quality of life. They’ll review which nonsurgical treatments you’ve tried and ask for your feedback on how well they’ve worked.

Be honest with your providers. It can be scary to consider surgery that permanently changes a joint in your foot, but don’t downplay your experiences. Tell your providers if foot pain or other symptoms are bad enough to make you avoid certain activities or types of movement, or if they make day-to-day activities hard.

Before your surgery date you’ll need:

• A physical exam to make sure you’re healthy enough for surgery.
• Imaging tests, including a foot X-ray. You might also need an MRI (magnetic resonance imaging) or CT scan (computed tomography scan).
• Blood tests.

Share all the medications and over-the-counter (OTC) or herbal supplements you take with your provider and surgeon. You may need to stop taking certain medications or supplements before your surgery.

Your surgeon will tell you when to fast the day before your surgery. Typically, people need to avoid eating and drinking for 12 hours before subtalar fusion surgery.

What happens during subtalar fusion surgery?

On the day of your surgery, you’ll receive anesthesia to numb your body and make sure you don’t feel any pain. An anesthesiologist will give you either general anesthesia to put you to sleep and/or a regional anesthesia to numb your foot and ankle.

During a subtalar fusion, your surgeon will permanently join the bones in your subtalar joint together.

Most subtalar fusions are open surgeries. That means your surgeon will make incisions (cuts) in your skin to operate on your foot joint. If you have an open subtalar fusion your surgeon will:

1. Make incisions in the skin around your subtalar joint.
2. Remove any damaged cartilage and bone.
3. Insert screws through the bones in your subtalar joint to join them together.
4. Secure the screws in place, then close the incisions.

Some people have ankle fusions done via an arthroscopy. This is a minimally invasive technique. Your surgeon will make smaller incisions in your foot than an open surgery. Then, they’ll insert a special tool called an arthroscope into your subtalar joint. The arthroscope includes a camera and a light that lets your surgeon see what’s going on inside your foot.

The steps will be the same. It just depends on which surgery technique is right for you.

How long does subtalar fusion surgery take?

It usually takes around two hours to perform a subtalar fusion. How long it takes your surgeon depends on which technique they’re using and how much damaged bone or cartilage they need to remove or reshape inside your subtalar joint.

What happens after subtalar fusion?

Subtalar fusions are usually outpatient procedures, so you can go home the same day. Your surgeon will put your foot in a brace or boot to keep it supported and prevent you from putting weight on it.

You’ll probably have to use crutches, a walker or other assistive devices and elevate your foot for a few weeks after your surgery.

What are the advantages of subtalar fusion?

The biggest advantage of subtalar fusion is how much it can improve your day-to-day pain level. People who’ve had a fusion surgery usually experience a significant improvement in pain and other symptoms — in some cases, symptoms completely go away after recovery. It’s a safe, effective way to relieve symptoms and improve your quality of life that other treatments couldn’t manage.

Most people can return to all their routine physical activities, including exercise.

What are the risks of having a subtalar fusion?

Although it’s rare, nonunion is the most common complication after subtalar fusion surgery. Nonunion happens when the bones in your foot don’t fuse together like they should. If your bones don’t heal into one bone after your surgery, you might need another operation.

Like any surgery, subtalar fusion has some risks, including:

• Reactions to anesthesia.
• Infections.
• Pain.
• Bleeding.

Having a subtalar fusion can permanently reduce the range of motion in your foot (how far you can move it). Because two bones have been joined to become one, you might not be able to rotate your foot as much or as smoothly after surgery. Even if it’s relatively common to lose some range of motion, the benefits outweigh the risks for most people who have severe foot pain. You might not be able to move your foot side-to-side as much, but you should experience significantly less pain.

How long does it take to heal from a subtalar fusion?

It usually takes several months to recover after subtalar fusion surgery.

As you heal, the two bones that were fused will grow together and become one. This will make your foot stronger, more stable and less painful. Everyone heals at their own natural pace, but it usually takes eight to 12 weeks for bones to fuse.

Can you walk after subtalar fusion?

Yes, you’ll still be able to walk and move after a subtalar fusion. It might take some time to adjust, but you should be able to walk and move once you recover. In fact, many people find walking and moving more comfortable because they feel so much less pain after surgery.

You’ll need physical therapy to help you regain strength as you heal. A physical therapist will help you start moving and using your foot safely. It usually takes a month or two before it’s safe to walk and put weight on your foot after surgery.

Your surgeon will tell you what to expect and when it’s safe to resume physical activities.

When should I call my healthcare provider?

Call your surgeon or healthcare provider right away if you experience any of the following symptoms:

• Fever higher than 101 degrees Fahrenheit (39 degrees Celsius).
• Signs of infection at your surgery site, including leaking, swelling, discoloration, odor or a feeling of warmth.
• New or worsening pain.
• Bleeding.

What is the success rate of subtalar fusion?

Subtalar fusion is a very effective surgery. Around 85% of people who have a subtalar fusion have a successful outcome. That means their pain and other symptoms noticeably and significantly get better and they don’t experience long-term complications or side effects.

One study found that people who also have an ankle fusion in the same foot that needs a subtalar fusion might have a lower success rate. Your surgeon will tell you what you can expect. They’ll help you make the best choice based on your health, goals and how much they think subtalar fusion can help you manage pain in your daily routine.

A note from Cleveland Clinic

You might not even know where or what your subtalar joint is, let alone why it might need surgery. Whether or not you can point to your subtalar joint on an anatomical diagram, you might be a good candidate for a subtalar fusion if you have severe foot pain that doesn’t get better after trying several nonsurgical treatments.

Joint fusion permanently joins two bones together so they heal to become one. This can affect how far you can move your subtalar joint. You might not be able to tilt or move your foot as far from side to side after surgery. But for most people, it’s worth it so they can live with significantly less (or no) pain. Talk to your surgeon or healthcare provider. They’ll help you understand why subtalar fusion might be a good option to help you get back on your feet and enjoy your favorite activities again.