In short
Subtalar arthritis is wear of the joint just below the ankle, between the talus and the heel bone. This joint lets the foot tilt side to side, so arthritis causes pain below the ankle that is worst on uneven ground. It most often follows a heel or talus fracture. Supportive shoes, insoles and injections help. For severe arthritis, a subtalar fusion is the gold standard and gives reliable pain relief.
What is the subtalar joint?
The subtalar joint sits below the ankle, between the talus and the calcaneus (heel bone). It allows side-to-side movement of the foot (inversion and eversion), which is essential for walking on uneven surfaces and keeping balance. In subtalar arthritis, its cartilage wears away.
What causes it?
- Previous injury. The most common cause, especially a fracture of the heel bone (calcaneus) or talus, or a severe sprain.
- Primary osteoarthritis, less common here than in the knee or hip.
- Inflammatory arthritis such as rheumatoid or psoriatic arthritis.
- Tarsal coalition, an abnormal bridge between foot bones present from birth.
- Foot shape. A flat or high-arched foot overloads the joint.
- Avascular necrosis of the talus, where loss of blood supply leads to collapse.
What are the symptoms?
- Deep aching pain below the ankle or on the outer side of the hindfoot
- Pain on uneven ground, slopes and stairs
- Stiffness when tilting the foot side to side
- Swelling around the hindfoot
- A feeling of unsteadiness on rough ground
- Difficulty with hiking or running
Treatment without surgery
- Activity changes and low-impact exercise.
- Supportive or rocker-soled shoes, ankle-supporting boots and custom insoles.
- Physiotherapy to strengthen surrounding muscles and keep nearby joints moving.
- Pain relief, including anti-inflammatory gels.
- Image-guided steroid injection. Relief during flare-ups, and helps confirm the joint is the source of pain.
Surgery
- Subtalar fusion. The gold standard for advanced arthritis. The talus and calcaneus are fixed together with screws so they heal as one, removing the painful movement.
- Double or triple fusion. The talonavicular and calcaneocuboid joints are also fused when arthritis or deformity is more widespread.
- Arthroscopic debridement. Removing loose bodies or spurs in early disease. Temporary benefit only.
Images from Prof Mason's practice
X-rays shown with patient identifiers removed. Results vary between patients.
Common questions
What is the recovery after subtalar fusion?
0 to 2 weeks: in a backslab or cast, no weight on the foot, foot raised, wound check. 2 to 6 weeks: cast or boot, still no weight on the foot, with a first X-ray to check healing. 6 to 12 weeks: gradually increasing weight in a boot as healing allows, then physiotherapy. Most people are back to normal walking by three to six months, with improvement continuing to a year.
Will I still be able to walk on uneven ground?
The foot will no longer tilt side to side at the fused joint, so very uneven ground needs more care. Most people walk comfortably on normal surfaces and find this a big improvement on the pain before surgery.
Talk it through with a specialist
Consultations at Spire Liverpool, Salford and the Isle of Man. New patients £250.
Consultant Foot and Ankle Surgeon, MB BCh, PhD, FRCS (Tr&Orth), FRCS (Glasg), SFHEA, FFSTEd. GMC 6074953. Hunterian Professor, Royal College of Surgeons of England.
Page last reviewed 25 October 2026. This information is general and does not replace an assessment.
Prof Mason's published research on this topic
Peer-reviewed papers by Prof Mason and his colleagues. Links open the paper or its PubMed record.
- Widnall J, Mason LW, Molloy A. Medial approach to the subtalar joint. Foot and Ankle Clinics, 2018.
- Durston A, Baboo R, Kadambande S, Hariharan K, Mason LW. Minimally invasive calcaneal osteotomies: are neurovascular structures at risk? A cadaveric study. Journal of Foot and Ankle Surgery, 2015.