• Journal of the Korean Arthroscopy Society
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• v.13 no.3
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• pp.235-241
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• 2009

The development of good quality small-diametered arthroscopes and refined arthroscopic techniques has contributed to the improvement of the subtalar arthroscopy. The therapeutic indications are synovectomy, removal of loose bodies, debridement and drilling of osteochondritis dissecans, excision of subtalar impingement lesions and osteophytes, lysis of adhesions for post-traumatic arthrofibrosis, removal of a symptomatic os trigonum, calcaneal fracture assessment and reduction, and arthroscopic arthrodesis of the subtalar joint. The subtalar arthroscopy can be done in supine position using thigh holder or in lateral decubitus position. The arthroscope generally used is a 2.7-mm 30 degrees short arthroscope. Noninvasive distraction with a strap around the hindfoot can be helpful. Usually anterolateral, middle and posterolateral portals are utilized for inspection and instrumentation within the joint. Twoportal posterior subtalar arthroscopy in prone position can be performed as well with 4.0-mm 30 degrees arthroscope, depending on the type and location of the subtalar pathology. The subtalar arthroscopy is a technically demanding procedure, which requires proper instrumentation and careful operative technique. Possible complications are nerve damage and persistent wound drainage.

• Journal of Korean Foot and Ankle Society
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• v.16 no.1
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• pp.26-30
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• 2012

The subtalar joint is a complex joint that is functionally responsible for inversion and eversion of the hindfoot. Advances in optical technology and surgical instrumentation have allowed the arthorscocpic surgeon to investiagate the small joints including the subtalar joint. Indications for subtalar arthroscopy include pain, swelling, stiffness and locking. Therapeutic indications include treatment of chondromalacia, osteophytes, arthrofibrosis, synovitis, loose bodies, osteochondral lesions, excision of a painful os trigonum, arthrodesis, and FHL tendinopathy. Contraindications to subtalar arthroscopy include infection, advanced osteoarthritis with deformity, severe edema, poor vascularity and poor skin quality. Subtalar arthroscopy is a technically demanding and difficult procedure that should only be performed by experienced surgeons. With proper instrumentation and careful operative techniques, satisfactory results may be obtained with minimal morbidity.

• Journal of Korean Foot and Ankle Society
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• v.6 no.2
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• pp.251-255
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• 2002

Purpose: Chronic subtalar instability is not common and similar to chronic ankle instability and the incidence and cause chronic subtalar instability are not well known. Recently we have experienced chronic subtalar instability without chronic ankle instability which was treated with modified Brostrom procedures. Materials and Methods: The patient is 46 year old man who has suffered from left ankle sprain for 30 years and recently aggravated more than twice a day. On subtalar stress view, 14 degree angulation of subtalar joint was noted and on anterior drawer view, 8 mm anterior displacement of left ankle was seen. Results: In operation, there was no anterior talofibular ligament abnormility but calcaneofibular ligament loosening was found. Ligament reconstruction was performed using modified Brostrom procedure. At 12 months after operation, the patient complains no pain and no limit of motion and no instability. Conclusion: We experienced chronic subtalar instability without ankle instability treated with modified Brostrom procedures. No instability was found after treatment without complication.

• Korean Journal of Applied Biomechanics
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• v.17 no.1
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• pp.135-144
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• 2007

The purpose of this study was to identify the effect of the subtalar sling ankle taping, by measuring changes in peak plantar pressure and subtalar angle during jump landing and walking in healthy subjects with subtalar sling ankle taping applied of the ankle joint. Fifty healthy subjects(8 males and 7 female, aged 22 to 25) were randomly divided into a participated in this study. They were free of musculoskeletal injury and neurologic deficit in lower extremity. The subjects were asked to perform 5M walking and single leg jump landing by under the guidance of physical therapists. Subtalar motions were typically measured as the angle made between the posterior aspect of the calcaneous and the posterior aspect of the lower leg during walking with taping or not. This measurement were made using a video system (30Hz sampling rate, rectified 60 Hz sampling rate). At the same time, peak lateral and vertical pressure were investigated using pressure distribution platforms(MatScan system) under foot during walking and single leg jump landing with taping or not. Statistical analysis was done by paired t-test and intraclass correlation coefficient [ICC(3.1)], using software SPSS. We have recently demonstrated significantly altered patterns of subtalr joint and peak plantar pressure when applied subtalar sling ankle taping(p<.05). Inversion angle of subtalar joint significantly decreased with taping(p<.05). The result suggest that pressure patterns observed in subjects are likely to result due to significant decrease in stress on ankle joint structures during jump landing and walking. Also, the result that the subtalar sling ankle taping procedure provides greater restiction of motion associated with ankle inversion. However, this study involved asymptomatic subjects without history of ankle inversion injury, further research is needed to assess the motion restraining effect of the subtalar sling ankle taping in subjects with lateral ankle instability.

• Journal of Korean Foot and Ankle Society
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• v.4 no.1
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• pp.39-43
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• 2000

A subtalar dislocation of the foot is a dislocation of the talonavicular and talocalcaneal joint while the tibiotalar relationship is unchanged. Posterior subtalar dislocation in particular, is a extremely rare. Only a few cases were reported previously in the literature. We treated a 25 year-old man who sustained the posterior subtalar dislocation in high energy traffic accident. The dislocation of subtalar joint was reduced by closed means with excellent clinical result. In this paper, we report 1 case of posterior dislocation of the subtalar joint and describe the pathomechanics, diagnosis, and treatment.

• Journal of Korean Foot and Ankle Society
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• v.10 no.1
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• pp.66-70
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• 2006

Purpose: To analyze the clinical and radiological outcome of subtalar arthrodesis using cannulated screws and morselized bone graft. Materials and Methods: Twenty one patients with follow-up of more than 1 year after subtalar arthrodesis were included in this study. Mean age was 40.8 years, and mean follow-up duration was 38 months. Underlying diseases were 19 cases of posttraumatic arthritis (18 calcaneal fractures and 1 talar fracture) and 2 cases of tarsal coalition. Clinically AOFAS ankle-hindfoot score, operation time, complication and satisfaction of patients were analyzed. Radiologically time to union, arthritis of surrounding joints, preoperative and postoperative talar declination angle were analyzed. Results: AOFAS ankle-hindfoot score was improved from preoperative 33 points to postooperative 79 points. Eighteen patients (86%) were satisfied with the results. Mean operation time was 91 minutes. All cases were fixed with 1-2 cannulated screws and morselized bone graft. Mean time to radiologic union was 12.1 weeks. There was 1 case of delayed union. There was no significant perioperative changes in talar declination angles. Conclusion: Subtalar arthrodesis using cannulated screws and morselized bone graft seems to be relatively simple and effective treatment method for subtalar arthritis.

• Journal of Korean Foot and Ankle Society
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• v.16 no.2
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• pp.116-122
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• 2012

Purpose: Subtalar arthrodesis has been the gold standard for the painful subtalar joint disorders. Successful subtalar arthrodesis requires fusion of the 3 facet joints. The purpose of the study is to compare the clinical outcome of the posterior fixation (P2) and anterior-posterior (A1P1) fixation technique for subtalar arthrodesis which enhance anterior and middle facet fixation. Materials and Methods: The study is based on the 20 feet (19 patients) of the subtalar arthrodesis utilizing cannulated screws from September 2006 to September 2009 with at least 1-year follow-up. Two fixation techniques were utilized for the subtalar arthrodesis: 1) posterior fixation only (P2, 7 feet, 35%) and 2) anterior-posterior (A1P1) fixation method (13 feet, 65%). Visual Analog Scale Pain (VAS) score, American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score (maximum: 94 points), the time for returning to daily living and the patient satisfaction were also evaluated. Results: Average follow-up period were 13.2 months (12-3 mo). The AOFAS score improved from preoperative average 45 (0-68) to 81.6 (62-94), while VAS score was decreased from average 8.0 (3-10) to 1.8 (0-5) at final follow-up. Ninety-five percent of the patients were satisfied with surgery. All the patients returned to daily living at average 7.2 months (2-15 mo) post-surgery. Radiographically, 2 techniques both showed 100% fusion of the posterior compartment of the subtalar joint. Postoperative complications were 1 case of low grade infection and 1 case of sural nerve neuralgia. Conclusion: The subtalar arthrodesis using A1P1 fixation technique showed better fusion rate of the anterior compartment of the subtalar joint compared to P2 fixation technique although the 2 techniques both showed similar favorable clinical outcome. Therefore the A1P1 fixation technique is found to be a viable option to address chronic painful subtalar joint disorders to enhance the anterior compartment fixation.

• Journal of Korean Physical Therapy Science
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• v.10 no.2
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• pp.42-52
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• 2003

An assessment of the subtalar joint in cerebral palsies can contribute to predict the function of ambulation in CP children. Ambulation is one of the most important function to guarantee the CP children independent life. This paper is to investigate some relationships between the function of standing and walling and the assessment of the subtalar joint in children with Cerebral palsy. And also to present the correlation between the ambulation and the Gross Motor Function Measures in children with cerebral palsy. Sixty-eight children with cerebral palsy were participated in this study. Evaluations of the subtalar pint parameters were performed by the goniometer and the angle finder, and the GMFM scores were measured by their teacher and researcher trained technically. A regression analysis was applied to figure out the relationship between the subtalar pint parameters(ROM and RCSP) and the function of standing and walking. A correlation analysis was employed to see how much the subtalar pint parameters could be predicted from GMFM scores in walling and standing. The results were as follows: 1) The significant differences were not observed between the total ROM, RCSP and the function of standing(F=8.065, p<.001) and walking(F=6.511, p<.001) in CP children. 2) The subtalar pint parameters(total ROM, RCSP) have the lower relevance to the function of standing and walling in CP children.(p>.05) 3) The total ROM and RCSP in both feet have the significant differences between the CP children and the normal children.(p<.001) 4) The GMFM scores were significantly correlated with the function of walling and standing in CP children.(r=247, p<.05) In this research, it is found that the significant relevance between the quantitative analysis of subtalar pint in children with cerebral palsy and the gross motor function of ambulation in standing and walling. However, it is difficult to predict the direct relationship of subtalar pint parameters and the function of ambulation, because subtalar pint scores and GMFM are only measured as quantities not qualities. Therefore, it is more reasonable to investigate the influence of subtalar pint parameters on ambulation in children with cerebral palsies, adding to the multifocal assessment of the children, rather than vice versa.

• Journal of Korean Foot and Ankle Society
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• v.2 no.1
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• pp.19-29
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• 1998

The characteristics of the patients after the calcaneal fracture that were associated with an unsatisfactory outcome were subtalar incongruity, decreased Bohler angle ratio of the fractured to the normal side, an age of more than fifty years, work involving strenuous labor, and increased time missed from work due to the injury. The purpose of this study was to examine the reliability of measurements of the range of motion of the subtalar joint. To determine reliability, evaluates of the correlatioinship between the degree of the displacement of the subtalar joint and Circle draw test after the calcaneal fracture. Fifty patients who had had fifty five calcaneal fractures were managed with open reduction and internal fixation. The results were reviewed retrospectively, between 4months and three years after the operation, with use of an evaluation system for the subtalar joint and with plain radiographs. At follow up evaluation, the result was assessed on the basis of restoration of anatomy and function of the subtalar joint. We evaluated the subtalar joint with plain films that consist of anteroposterior projection, lateral projection, calcaneal axial view, and Broden's view, and the measurements of the displacement of the subtalar joint surface after the calcaneal fracture. And we evaluated the range of motion of the subtalar joint with Circle draw test for physical evaluation. Circle draw test was evaluated and demonstrated the motion of flexion-supination-adduction and extension-pronation-abduction of the subtalar joint. And there are correlationship between the degree of the displacement and range of motion of the subtalar joint after the calcaneal fracture. The report critically reviews methords used to measure Circle draw test for physical examination of the follow up after the calcaneal fracture.

• Physical Therapy Korea
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• v.26 no.3
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• pp.23-31
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• 2019

Background: Measurement of passive ankle dorsiflexion range of motion (ADROM) is often part of a physical therapy assessment. Objects: The objective of this study was to identify the effects of subtalar joint neutral position (SJNP) on passive ADROM according to knee position in young adults. Methods: We recruited 14 young adult participants for this study. Two examiners used a universal goniometer to measure passive ADROM with and without SJNP. Dorsiflexion force was applied to the forefoot until maximum resistance was reached in two knee positions (extension and $90^{\circ}$ flexion) in the prone position. Subtalar joint position was also recorded at maximum ADROM. Passive ADROM was measured three times at different knee and subtalar joint positions, in random order. Two-way repeated-measures analysis of variance was used to compare the effects of subtalar joint and knee position on passive ADROM. Results: Passive ADROM was significantly lower with than without SJNP during both knee extension (mean difference: $7.4^{\circ}$) and $90^{\circ}$ flexion (mean difference: $16.9^{\circ}$) (p<.01). Passive ADROM was significantly higher during $90^{\circ}$ knee flexion than during knee extension both with (mean difference: $5.8^{\circ}$) and without SJNP (mean difference: $15.2^{\circ}$) (p<.01). The valgus position of the subtalar joint was significantly lower with than without SJNP during both knee extension (mean difference: $3.3^{\circ}$) and $90^{\circ}$ flexion (mean difference: $4.3^{\circ}$) (p<.01). Conclusion: Our results indicate that the gastrocnemius may limit ankle dorsiflexion more than the soleus does. Greater dorsiflexion at the subtalar and midtarsal joints was observed during passive ADROM measurement without than that with SJNP; therefore, SJNP should be maintained for accurate measurement of ADROM.