[Surgical fusion of the subtalar joint--changing concepts in changing times]

Triple arthrodesis respects the functional unit of the subtalar joint, but shows several intraoperative difficulties such as surfaces of resection that are too large or wrong positions between the hind and the middle foot. Furthermore postoperative problems like walking on uneven pavements, a reduced range of motion in the adjacent joints and the development of osteoarthritis of the ankle are not easy to deal with. Therefore isolated fusions of the talocalcaneal, talonavicular and calcaneo-cuboidal joint with a minimal resection technique seem to present several advantages. Among them we would mention a minimal reduction of the range of motion, the preservation of a physiological position of the adjacent joints and the prevention of osteoarthritis in the adjacent joint which rarely appears and when it does only in an asymptomatic form. The subtalar implants and the astragaloplasty as possibilities to treat disorders of the subtalar joint complex are also discussed.