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PATHOLOGIES
MIDFOOT AND HINDFOOT CONDITIONS
Hindfoot Arthritis
What is it?
Hindfoot arthritis refers to degenerative changes affecting one or more of the joints in the back of the foot, specifically:
- Subtalar joint (below the ankle – allows side-to-side motion)
- Talonavicular joint
- Calcaneocuboid joint
These joints are critical for shock absorption and foot mobility, especially on uneven ground. When affected by arthritis, they can become stiff, painful, and swollen, limiting walking and mobility.
CAUSES
- Post-traumatic arthritis – after a fracture or dislocation (especially calcaneus or talus)
- Primary osteoarthritis – age-related degeneration
- Inflammatory arthritis – such as rheumatoid arthritis or psoriatic arthritis
- Tarsal coalition – congenital fusion of bones may lead to early arthritis
- Posterior tibial tendon dysfunction – can cause valgus alignment and joint overload
SYMPTOMS
- Deep aching pain in the back or outer side of the foot
- Stiffness, especially when walking on uneven surfaces
- Swelling over the hindfoot joints
- Difficulty standing or walking for long periods
- Deformity or instability in advanced cases (e.g. flatfoot or heel valgus)
DIAGNOSIS
- Clinical exam: Localised tenderness, stiffness, and difficulty with inversion/eversion
- X-rays: Reveal joint space narrowing, bone spurs, and sclerosis
- CT scan: Provides detailed assessment of joint degeneration and alignment
- MRI: May be useful in inflammatory arthritis or early-stage disease
TREATMENT OPTIONS
Non-Surgical
- Activity modification and low-impact exercises
- NSAIDs for pain and inflammation
- Bracing (e.g. lace-up ankle brace or custom AFO) to reduce joint motion
- Custom orthotics to improve alignment and offload painful joints
- Corticosteroid injections for temporary relief
Surgical
- Arthrodesis (joint fusion) is the most common surgical treatment:
- Subtalar fusion – isolates side-to-side hindfoot motion
- Triple fusion – fuses the subtalar, talonavicular, and calcaneocuboid joints for more severe or widespread arthritis
- Realignment procedures may be performed in conjunction with fusion for deformity correction
PROGNOSIS
- Non-surgical treatments may provide relief in early or mild cases.
- Surgical fusion is reliable for pain relief and stability but sacrifices joint motion.
- Outcomes are generally excellent with appropriate procedure selection and rehabilitation.
