SUBTALAR ARTHROEREISIS
- Method
- An implant in the sinus tarsi limits the tipping of the heel
- Duration
- 20 to 40 minutes
- Recovery time
- 6 weeks to 3 months
In a flexible flatfoot the heel tips outwards and the long arch sinks. Between the talus and the heel bone lies a funnel-shaped channel, the sinus tarsi – precisely the space that closes up as the heel tips.
Subtalar arthroereisis places an implant there. It fuses nothing and is not anchored in bone; it works as a stop, limiting the movement without abolishing it. The foot rises and stays mobile.
How the operation proceeds
The operation rarely takes longer than half an hour. Through a small incision on the outer side below the ankle bone the sinus tarsi is reached and a guide wire placed. Trial implants over that wire show which size lifts the heel upright without blocking the movement.
We use the TarsiTree system. It comes in two shapes – a conical one with a broad seat and a waisted one that sits deeper – in six sizes each.
The correction is checked while the patient is still on the table: the heel should sit straight under the lower leg, and the foot should still move inwards and outwards. An implant that is too large presses; one that is too small does not correct.
If the calf is shortened and pulls the heel upwards, it is lengthened in the same operation. Otherwise it works against the correction.
When the operation is considered
The condition is a foot that can still rise – on tiptoe or during the examination. If the deformity has stiffened, the implant does not help; osteotomies are then the way forward.
Conservative treatment always comes first: insoles, stretching, strengthening, and in children simply time. We operate when the foot hurts nonetheless and the symptoms govern everyday life – not because an X-ray shows a deformity.
Aftercare following arthroereisis
The operation is small and the aftercare correspondingly manageable. What the foot mainly needs is time to get used to its new position.
Phase I (0–2 weeks): Getting going
- Weight-bearing in a postoperative shoe or a comfortable ordinary shoe, as symptoms allow
- Elevation and cooling in the first few days
- Wound checks; stitches out after about two weeks
- A pulling sensation in the sinus tarsi during the first weeks is normal
Phase II (2–6 weeks): Settling in
- Step by step back into a normal shoe and into everyday life
- Physiotherapy: stretching the calf, strengthening the muscles of the foot
- Gait training – the foot now rolls differently from what you are used to
From week 6: Loading and sport
- Everyday life is usually unrestricted again
- Sport after about three months, running-intensive sports last of all
- A check after one year; the implant is usually removed after one to two years
- If pressure pain in the sinus tarsi persists, it can come out earlier
Our foot specialists
Specialists in foot deformities in children, adolescents and adults
