Results of in situ subtalar arthrodesis for late sequelae of calcaneus fractures

A retrospective review was performed on all patients who had an in situ sub talar arthrodesis for painful sequelae of calcaneus fractures between 1989 and 1994, Nineteen feet were available for evaluation, with a mean follow-u p of 27 months (range, 12-62 months). Lateral calcaneal wall decompression was performed in seven feet. Although loss of ankle dorsiflexion was associ ated with anterior ankle tenderness, loss of ankle dorsiflexion was not cor related with either talar declination angles or talar height differences. T here was no correlation between American Orthopaedic Foot and Ankle Society hindfoot score and talar declination, talar height, or calcaneal width. Pe roneal tendon/subfibular impingement, ankle tenderness, sural nerve injury, and patient smoking were all statistically associated with lower scores. T he calcaneocuboid joint was frequently involved in the fracture but was not painful at follow-up. Late pain after a calcaneal fracture is not caused b y only subtalar arthrosis. Radiographic criteria alone cannot be relied upo n for surgical decision making. Careful physical evaluation should be used to determine sources of pain. Distraction arthrodesis should be considered only if findings of anterior ankle impingement are present. If sural nerve symptoms are present, a sural neurectomy may be added to the procedure. Pai n localized to the plantar fat pad should be managed nonoperatively, Radiog raphic changes in the calcaneocuboid joint rarely require surgical interven tion, Based on these results, in situ subtalar arthrodesis with lateral wal l decompression is the procedure of choice in most cases of subtalar trauma tic arthritis with lateral wall impingement.