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.