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Subtalar Joint Injection

From WikiSM

Other Names

  • Subtalar Joint Injection
  • Subtalar Joint Aspiration
  • Subtalar Joint Arthrocentesis

Background

The subtalar joint. Articulation of the calcaneus with the talus bone can be seen. The red arrows show the subtalar joint on a lateral X-ray and illustration. The red dashed lines represent the talocalcaneonavicular joint while the blue dots represent the talocalcaneal joint.[1]

Key Points

  • Needle: 22-25 gauge, 1.5 inch needle
  • Transducer: high frequency, linear
  • The posterolateral approach is recommended because it is not adjacent to any neurovascular bundles

Anatomy of the Subtalar Joint

  • Articulation of the talus on the calcaneus
  • Composed of posterior, middle and anterior facets
  • Posterior facet is largest and most easily accessed
  • The subtalar joint confers most of the inversion/eversion motion of the hindfoot

Palpation Guidance vs Ultrasound Guidance

  • We recommend ultrasound guided aspiration/injection when possible
  • To date, there are no studies comparing ultrasound and palpation guided approaches

Indications

Contraindications

  • Absolute
    • Anaphylaxis to injectates
    • Overlying cellulitis, skin lesion or systemic infection
  • Relative
    • Can be treated with less invasive means
    • Hyperglycemia or poorly controlled diabetes
    • Lack of symptom improvement with previous injection

Procedure

View of subtalar joint from the posterolateral position in long axis[2]
Patient, transducer and needle position for the posterolateral approach[2]
Ultrasound view of long axis, in plane approach with needle visualized[2]

Equipment

  • Sterile prep (i.e. chloraprep, chlorhexidine, iodine, etc)
  • Gloves
  • Needle: typically 21-25 gauge, 1.5 inch
  • Syringe: 5-10 mL
  • Gauze
  • Ethyl Chloride
  • Bandage
  • Injectate
    • Local anesthetic
    • Corticosteroid
  • Sterile probe cover

Ultrasound Findings

  • Common ultrasound findings include:
    • Distension of joint capsule

Ultrasound Guided Technique: Long Axis, In Plane

  • Patient Position
    • Patient is prone, foot hanging off table
  • Transducer Position
    • Posterolateral to Achilles tendon
    • Beam angled slightly medial
  • Needle Approach/ Orientation
    • In plane
    • Distal to proximal
  • Target
    • Talocalcaneal joint space
  • Pearls and Pitfalls
    • Angle of approach is steep, making the procedure technically challenging
    • Can aspirate from this position as well as inject

Aftercare

  • Motor exam should be intact
  • No major restrictions in most cases
  • Can augment with ice, NSAIDS
  • Consider Ankle Compression Sleeve

Complications

  • Infection
  • Damage to surrounding tissue

See Also

References

  1. ↑ Ghali, Abdullah, et al. "Arthroereisis: treatment of pes planus." Cureus 14.1 (2022).
  2. ↑ 2.0 2.1 2.2 Malanga, Gerard A., and Kenneth R. Mautner. "Atlas of ultrasound-guided musculoskeletal injections." (No Title) (2014).
Created by:
John Kiel on 22 May 2025 18:09:13
Authors:
Last edited:
22 May 2025 18:25:36
Category:
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