Subtalar instability. Etiology, diagnosis, and management

Area of Science:

• Orthopedics
• Sports Medicine
• Biomechanics

Background:

• Subtalar instability is a significant contributor to chronic hindfoot instability, frequently co-occurring with ankle instability.
• Injury mechanisms often involve hindfoot supination, leading to attenuation of lateral ankle and subtalar ligaments.
• Progressive sprains due to altered subtalar mechanics further weaken remaining ligaments.

Purpose of the Study:

• To review the diagnosis and management of subtalar instability.
• To highlight the role of conservative and surgical interventions.
• To discuss current trends in surgical reconstruction for subtalar instability.

Main Methods:

• Diagnosis is inferred from patient history, physical examination, radiographic studies, and failed conservative treatment.
• Conservative management includes early measures like ice and immobilization, and late measures such as bracing and proprioceptive training.
• Surgical management involves ligamentous reconstruction to restore lateral ligament structures.

Main Results:

• No single conclusive diagnostic test exists for subtalar instability.
• Many patients benefit from conservative treatments, but some require surgical intervention.
• Ligamentous reconstruction, particularly of the calcaneofibular, cervical, and interosseous talocalcaneal ligaments, shows promise for hindfoot stabilization.

Conclusions:

• Subtalar instability requires a comprehensive diagnostic approach combining clinical and imaging findings.
• Conservative management is the first line of treatment, but surgical reconstruction is a viable option for refractory cases.
• Emerging surgical techniques may allow for earlier anatomic repair and rehabilitation.