The subtalar joint is a complex joint in the foot. It is vital for walking, and helps people balance on uneven or rough ground. Damage can result from wear and tear or injuries. It may cause pain and affect a person’s mobility or gait.

This article explains what the subtalar joint is and how it works. It will also look at some of the more common reasons for subtalar joint pain and treatment options.

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The American Academy of Orthopedic Surgeons (AAOS) describes the subtalar joint as the connection between the heel bone (the calcaneus) and the bone that forms the lower part of the ankle (the talus). The talus bone supports the weight of the tibia and fibula leg bones above.

The subtalar joint sits below the talus joint. It plays a major role in walking, as it allows the foot to roll inward and outward. This is particularly important when walking on uneven ground.

A 2017 article explains that tendons and ligaments support the subtalar joint. Tendons are connective tissues that connect muscle to bone, while ligaments are connective tissues that connect bones to other bones. Damage to these connective tissues can cause the subtalar joint to become unstable and cause ankle injuries.

Damage to the subtalar joint can occur for many reasons, including:

  • Osteoarthritis: Also known as age-related or wear-and-tear arthritis.
  • Autoimmune diseases: Examples include lupus and rheumatoid arthritis (RA).
  • Sprains: These injuries involve stretching or tearing of ligaments.
  • Strains: These injuries involve stretching or tearing of muscles or tendons.
  • Fractures: According to the AAOS, a fractured talus bone causes pain in the subtalar joint.
  • Dislocation: This injury involves bones popping or slipping out of alignment. According to a 2022 article, subtalar dislocations are rare and often result from:
    • an automobile accident
    • falling from a great height
    • sports involving repeated jumping and landing, such as basketball

A 2017 article explains that people with damaged subtalar joints often experience pain on the sides of their feet, near to the heel. Usually, the pain is on the outside of the foot. However, it can occur on either or both sides.

Other symptoms of subtalar joint pain include:

  • persistent pain in the lower part of the ankle, which typically worsens following physical activity or long periods of standing
  • difficulty walking, particularly on slopes or uneven ground
  • swelling

Without treatment, a damaged subtalar joint can cause permanent damage to the foot.

The American Podiatric Medical Association (APMA) recommend that people see a doctor if they experience any of the following symptoms relating to their feet or ankles:

  • increased pain
  • redness or bruising
  • swelling
  • difficulty walking following an injury

Other recommendations seeking immediate medical advice if people are in severe pain or are unable to put any weight on their foot,

Before doctors can recommend treatment for subtalar joint pain, they need to establish the cause of the pain.

A doctor will check the person’s foot and ankle for any obvious signs of injury and will establish if there is any pain when turning the foot. They may then recommend X-rays to check for broken or dislocated bones and ultrasounds or MRI scans to check for any soft tissue damage.

The treatment for subtalar joint pain depends on the underlying cause and include:.

RICE

Other recommendations for treating foot or ankle sprains or strains at home include RICE, which stands for:

  • Rest: Avoiding walking or putting weight on the sore foot.
  • Ice: Applying a cool pack to the affected area to reduce inflammation. A person can apply the cool pack for up to 15 minutes every few hours until the swelling subsides.
  • Compression: Bandaging the foot with an elastic bandage to reduce swelling.
  • Elevation: Keeping the foot elevated on pillows to reduce swelling.

Over-the-counter anti-inflammatories

According to the Centers for Disease Control and Prevention (CDC), doctors may prescribe over-the-counter (OTC) anti-inflammatory medications to treat joint pain and inflammation due to arthritis. The CDC explains that studies have shown these medications to be more effective than opioids at reducing the severity of pain.

Orthotics

A 2018 review article suggests that orthotics or ankle braces can reduce subtalar pain by supporting the hindfoot. If a person has arthritis around the subtalar joint, a foot orthotic may help keep the heel and hindfoot properly aligned.

A podiatrist can look at a person’s standing stance and check their gait while they walk. They can then make recommendations about the most suitable orthotics.

Surgery

Some people may require surgery if they have fractured or dislocated the subtalar joint.

According to a 2022 review article, there are some surgical options, including fusing the joint. A 2019 study describes subtalar fusion surgery as the gold standard treatment for severe cases. This procedure involves inserting parallel screws through the talus and calcaneus bones to stabilize the joint.

However, an article in the Orthopaedic Journal of Sports Medicine advises trying nonsurgical treatments for at least 3 months before considering surgery.

Physical therapy may help reduce pain, improve range of motion, decrease stiffness, and maintain flexibility.

The subtalar joint is located between the ankle bone and heel bone. It helps keep the body stable while walking by allowing the foot to roll in and out.

Problems with the subtalar joint can lead to gait and mobility issues, particularly when a person is walking on uneven ground. Without treatment, damage to the subtalar joint may become permanent.

Noninvasive treatments are typically the first-line treatment for subtalar joint pain. However, surgery may be necessary if the pain is ongoing. Individuals can talk with their doctors about their diagnosis and treatment options.