Subtalar Joint: Difference between revisions

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== Introduction ==
== Introduction ==
[[File:Subtalar joint.png|thumb|Subtalar joint]]
[[File:Subtalar joint.png|thumb|Subtalar joint]]
The subtalar (ST) joint is an articulation between two of the tarsal bones in the foot, the [[talus]] and [[calcaneus]]. The joint is classed structurally as a [[Synovial Joints|synovial joint]], and functionally as a plane synovial joint.
The subtalar (ST) joint is an articulation between two of the tarsal bones in the foot: the [[talus]] and [[calcaneus]]. The joint is classed structurally as a [[Synovial Joints|synovial joint]], and functionally as a plane synovial joint.


The ST joint allows inversion and eversion of the foot.
The ST joint allows for rotation of the foot, clinically known as inversion and eversion of the foot<ref name=":0">Krähenbühl N, Horn-Lang T, Hintermann B, Knupp M. [https://eor.bioscientifica.com/view/journals/eor/2/7/2058-5241.2.160050.xml The subtalar joint: a complex mechanism]. EFORT open reviews. 2017 Jul 6;2(7):309-16.</ref>.


Inversion and eversion allows<ref>Brukner P et al. Brukner & Khan's Clinical Sports medicine 5th edition. Sydney, Australia: Mc Graw hill  education; 2017. p893-895</ref>:
Inversion and eversion allows<ref>Brukner P et al. Brukner & Khan's Clinical Sports medicine 5th edition. Sydney, Australia: Mc Graw hill  education; 2017. p893-895</ref>:
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== Structure ==
== Structure ==
[[File:Subtalar Joint.png|thumb|Subtalar ligaments Superior view|alt=|300x300px]]
[[File:Subtalar Joint.png|thumb|Subtalar ligaments Superior view|alt=|300x300px]]
The ST joint is multi-articular joint, with three articulated facets that provide a surface for the joint to glide<ref>Rockar Jr PA. [https://www.jospt.org/doi/epdf/10.2519/jospt.1995.21.6.361 The subtalar joint: anatomy and joint motion.] Journal of Orthopaedic & Sports Physical Therapy. 1995 Jun;21(6):361-72.</ref>:
The ST joint is multi-articular joint, with three articulated facets that provide a surface for the joint to glide.<ref>Rockar Jr PA. [https://www.jospt.org/doi/epdf/10.2519/jospt.1995.21.6.361 The subtalar joint: anatomy and joint motion.] Journal of Orthopaedic & Sports Physical Therapy. 1995 Jun;21(6):361-72.</ref> The ST joint can be divided into two parts:


# The anterior subtalar joint : Allows joint to glide forward (anterior articulation)
# The anterior subtalar part: talar head articulating with the anterior and middle facets of the calcaneus<ref name=":0" />. Which allows glide forward (anterior articulation)
# The medial subtalar joint: Allows joint to glide side-to-side (eversion/inversion)
# The posterior subtalar part: the concave facet of the talus lies on the convex posterior facet of the calcaneus<ref name=":0" />. Which allows glide backwards (posterior articulation)
# The posterior subtalar joint: Allows the to glide backward (posterior articulation)
[[File:Talus, seen from below.png|thumb|Talus, seen from below|alt=|300x300px]]
[[File:Talus, seen from below.png|thumb|Talus, seen from below|alt=|300x300px]]
The talus and calcaneous bones are held in place by strong but flexible connective ligaments. The main ligament that attaches these bones is called the interosseous talocalcaneal ligament. Four other weaker ligaments provide the joint with added stability<ref name=":1">Very well health Subtalar joint Available: https://www.verywellhealth.com/what-is-the-subtalar-joint-1337686<nowiki/>(accessed 5.6.2022)</ref>. The interosseous talocalcaneal ligament, acts to bind the talus and calcaneus together. It lies within the sinus tarsi (a small cavity between the talus and calcaneus), and is particularly strong; providing the majority of the ligamentous stability to the joint<ref name=":0">Teach me anatomy The subtalar loint Available:https://teachmeanatomy.info/lower-limb/joints/subtalar/ (accessed 5.6.2022)</ref><ref name=":2">Kenhub Subtalar joint Available: https://www.kenhub.com/en/library/anatomy/subtalar-joint<nowiki/>(accessed 5.6.2022)</ref>.


In between the calcaneus and talus is the synovial membrane. This tissue secretes fluid to lubricate the joint space, protecting the cartilage and bones from damage.
 
There are several ligaments around the subtalar joint which provide stability. They can be classified as intrinsic (cervical ligament, interosseous talo-calcaneal ligament) and extrinsic ligaments (calcaneo-fibular ligament, deltoid ligament)<ref name=":0" />.


== Movements ==
== Movements ==
The movements that occur at the subtalar joint are gliding and rotation.The combination of these movements result in pronation and supination; these are considered to be the primary movements in the subtalar joint. They are always accompanied by movements in the talocalcaneonavicular and calcaneocuboid joints and as such these three joints are considered to be one functional unit of the foot.<ref name=":2" /><ref name=":0" />.
The movements that occur at the subtalar joint are gliding and rotation. The combination of these movements clinically are known as inversion and eversion; these are considered to be the primary movements in the subtalar joint<ref name=":0" />.  


# Supination in the subtalar joint is primarily produced by [[Tibialis Anterior|tibialis anterior]] and [[Tibialis Posterior|tibialis posterior]], with assistance from [[Extensor Hallucis Longus|extensor hallucis longus]], [[flexor hallucis longus]] and [[flexor digitorum longus]].
The mechanics of the foot is not in isolation. It is accompanied by movements in the talocalcaneonavicular and calcaneocuboid joints<ref name=":1">Seringe R, Wicart P, French Society of Pediatric Orthopaedics (SOFOP. [https://www.sciencedirect.com/science/article/pii/S1877056813001254 The talonavicular and subtalar joints: the “calcaneopedal unit” concept.] Orthopaedics & Traumatology: Surgery & Research. 2013 Oct 1;99(6):S345-55.</ref>.
# Pronation is mainly produced by [[Peroneus (Fibularis) Longus Muscle|fibularis longus]], [[Peroneus Brevis|fibularis brevis]] and fibularis tertius with assistance from the extrinsic muscles that extend the toes ([[Extensor Digitorum Longus|extensor digitorum longus]] and [[Extensor Hallucis Longus|extensor hallucis longus]])<ref name=":2" />.
 
# '''Supination''' in the subtalar joint is primarily produced by [[Tibialis Anterior|tibialis anterior]] and [[Tibialis Posterior|tibialis posterior]], with assistance from [[Extensor Hallucis Longus|extensor hallucis longus]], [[flexor hallucis longus]] and [[flexor digitorum longus]].
# '''Pronation''' is mainly produced by [[Peroneus (Fibularis) Longus Muscle|fibularis longus]], [[Peroneus Brevis|fibularis brevis]] and fibularis tertius with assistance from the extrinsic muscles that extend the toes ([[Extensor Digitorum Longus|extensor digitorum longus]] and [[Extensor Hallucis Longus|extensor hallucis longus]]).


== Function ==
== Function ==
[[File:Ankle Pronation Position.png|thumb|Ankle and foot in Neutral and Over-pronation|alt=|243x243px]]
[[File:Ankle Pronation Position.png|thumb|Ankle and foot in Neutral and Over-pronation|alt=|243x243px]]
The ST joint is key to many functional activities eg walking and running, and posture while performing these tasks. The mechanisms behind how the subtalar joint propels you us is very complex.
The ST joint is key to many functional activities such as walking and running. The mechanisms behind how the subtalar joint propels you us is very complex<ref name=":1" />.


This ST joints primary movements involve supination, in which the foot rolls toward the body's midline, and pronation, in which the foot rolls away from the midline. Both of these movements require a combination of distinct actions.
This ST joints primary movements involve supination, in which the foot rolls toward the body's midline, and pronation, in which the foot rolls away from the midline. Both of these movements require a combination of distinct actions.


* Pronation requires a combination of dorsiflexion, abduction, and eversion.
* Pronation requires a combination of dorsiflexion, abduction, and eversion.
* Supination requires a combination of plantar flexion, adduction and inversion<ref name=":1" />
* Supination requires a combination of plantar flexion, adduction and inversion


== Physiotherapy Relevance ==
== Physiotherapy Relevance ==
[[File:Subtalar dislocation.jpg|thumb|Medial ST dislocation]]
[[File:Subtalar dislocation.jpg|thumb|Medial ST dislocation]]
The subtalar joint is essential for mobility, and as such is prone to wear and tear, trauma, and joint-specific disorders. Any damage done to the subtalar joint and surrounding soft tissues that support it may lead to pain, and foot deformity (often permanent), and affect gait and mobility. Conditions affecting this joint include the below:
The subtalar joint is essential for mobility, and as such is prone to degeneration as with every weight bearing joint, trauma, and joint-specific disorders such as instability<ref name=":0" />. Any damage done to the subtalar joint and surrounding soft tissues that support it may lead to pain, foot deformity (often permanent), and affect gait and mobility. Conditions affecting this joint include the below:
[[File:Subtalar-osteoarthritis.jpeg|thumb|Subtalar-osteoarthritis]]
[[File:Subtalar-osteoarthritis.jpeg|thumb|Subtalar-osteoarthritis]]
'''Directly Joint Related'''
'''Directly Joint Related'''


# [[Juvenile Rheumatoid Arthritis]]: The subtalar joint is often the first joint affected
# [[Juvenile Rheumatoid Arthritis]]: The subtalar joint is often the first joint affected
# [[Subtalar Joint Arthritis|Osteoarthritis]]: eg [[Calcaneal Fractures|Calcaneal fracture]] (subtalar joint is usually disrupted, causing the joint to become arthritic)<ref name=":0" />.  
# [[Subtalar Joint Arthritis|Osteoarthritis]]
# [[Rheumatoid Arthritis|Rheumatoid arthritis]]: Primarily attacks joint tissues, often the ankle and foot<ref name=":1" />
# [[Calcaneal Fractures|Calcaneal fracture]] (subtalar joint is usually disrupted, causing the joint to become arthritic).
#[[Rheumatoid Arthritis|Rheumatoid arthritis]]: Primarily attacks joint tissues, often the ankle and foot
# Instability of the ST joint.
# [[Subtalar dislocation]] occurs through the disruption of 2 separate bony articulations, the talonavicular and talocalcaneal joints
[[File:Download (2).jpg|thumb|Pes Planus|alt=|160x160px]]
[[File:Download (2).jpg|thumb|Pes Planus|alt=|160x160px]]
'''Disorders in which the subtalar joint is indirectly affected or affected as a result of another defect or injury to the foot or ankle.''' Include:


# [[Pes cavus]]/[[Pes Planus|Pes planus]]
 
# [[Subtalar dislocation]] occurs through the disruption of 2 separate bony articulations, the talonavicular and talocalcaneal joints
'''Disorders in which the subtalar joint is indirectly affected or affected as a result of another defect or injury to the foot or ankle:'''
# [[Chronic Ankle Instability]]
 
# [[Tarsal Coalition|Tarsal coalition]]<ref name=":1" />
#[[Pes cavus]]/[[Pes Planus|Pes planus]]
# [[Sinus Tarsi Syndrome|Sinus tarsi syndrome]]
#[[Chronic Ankle Instability]]
#[[Tarsal Coalition|Tarsal coalition]]
#[[Sinus Tarsi Syndrome|Sinus tarsi syndrome]]


== References  ==
== References  ==

Revision as of 10:40, 8 September 2022

Original Editor - Lucinda hampton

Top Contributors - Lucinda hampton, Vidya Acharya, Abbey Wright and Kim Jackson  

Introduction[edit | edit source]

Subtalar joint

The subtalar (ST) joint is an articulation between two of the tarsal bones in the foot: the talus and calcaneus. The joint is classed structurally as a synovial joint, and functionally as a plane synovial joint.

The ST joint allows for rotation of the foot, clinically known as inversion and eversion of the foot[1].

Inversion and eversion allows[2]:

  • The foot and ankle to pivot/change directions,
  • stay balanced
  • walk across uneven terrain.
  • act as a shock absorber

Structure[edit | edit source]

Subtalar ligaments Superior view

The ST joint is multi-articular joint, with three articulated facets that provide a surface for the joint to glide.[3] The ST joint can be divided into two parts:

  1. The anterior subtalar part: talar head articulating with the anterior and middle facets of the calcaneus[1]. Which allows glide forward (anterior articulation)
  2. The posterior subtalar part: the concave facet of the talus lies on the convex posterior facet of the calcaneus[1]. Which allows glide backwards (posterior articulation)
Talus, seen from below


There are several ligaments around the subtalar joint which provide stability. They can be classified as intrinsic (cervical ligament, interosseous talo-calcaneal ligament) and extrinsic ligaments (calcaneo-fibular ligament, deltoid ligament)[1].

Movements[edit | edit source]

The movements that occur at the subtalar joint are gliding and rotation. The combination of these movements clinically are known as inversion and eversion; these are considered to be the primary movements in the subtalar joint[1].

The mechanics of the foot is not in isolation. It is accompanied by movements in the talocalcaneonavicular and calcaneocuboid joints[4].

  1. Supination in the subtalar joint is primarily produced by tibialis anterior and tibialis posterior, with assistance from extensor hallucis longus, flexor hallucis longus and flexor digitorum longus.
  2. Pronation is mainly produced by fibularis longus, fibularis brevis and fibularis tertius with assistance from the extrinsic muscles that extend the toes (extensor digitorum longus and extensor hallucis longus).

Function[edit | edit source]

Ankle and foot in Neutral and Over-pronation

The ST joint is key to many functional activities such as walking and running. The mechanisms behind how the subtalar joint propels you us is very complex[4].

This ST joints primary movements involve supination, in which the foot rolls toward the body's midline, and pronation, in which the foot rolls away from the midline. Both of these movements require a combination of distinct actions.

  • Pronation requires a combination of dorsiflexion, abduction, and eversion.
  • Supination requires a combination of plantar flexion, adduction and inversion

Physiotherapy Relevance[edit | edit source]

Medial ST dislocation

The subtalar joint is essential for mobility, and as such is prone to degeneration as with every weight bearing joint, trauma, and joint-specific disorders such as instability[1]. Any damage done to the subtalar joint and surrounding soft tissues that support it may lead to pain, foot deformity (often permanent), and affect gait and mobility. Conditions affecting this joint include the below:

Subtalar-osteoarthritis

Directly Joint Related

  1. Juvenile Rheumatoid Arthritis: The subtalar joint is often the first joint affected
  2. Osteoarthritis
  3. Calcaneal fracture (subtalar joint is usually disrupted, causing the joint to become arthritic).
  4. Rheumatoid arthritis: Primarily attacks joint tissues, often the ankle and foot
  5. Instability of the ST joint.
  6. Subtalar dislocation occurs through the disruption of 2 separate bony articulations, the talonavicular and talocalcaneal joints
Pes Planus


Disorders in which the subtalar joint is indirectly affected or affected as a result of another defect or injury to the foot or ankle:

  1. Pes cavus/Pes planus
  2. Chronic Ankle Instability
  3. Tarsal coalition
  4. Sinus tarsi syndrome

References[edit | edit source]

  1. ↑ 1.0 1.1 1.2 1.3 1.4 1.5 Krähenbühl N, Horn-Lang T, Hintermann B, Knupp M. The subtalar joint: a complex mechanism. EFORT open reviews. 2017 Jul 6;2(7):309-16.
  2. ↑ Brukner P et al. Brukner & Khan's Clinical Sports medicine 5th edition. Sydney, Australia: Mc Graw hill education; 2017. p893-895
  3. ↑ Rockar Jr PA. The subtalar joint: anatomy and joint motion. Journal of Orthopaedic & Sports Physical Therapy. 1995 Jun;21(6):361-72.
  4. ↑ 4.0 4.1 Seringe R, Wicart P, French Society of Pediatric Orthopaedics (SOFOP. The talonavicular and subtalar joints: the “calcaneopedal unit” concept. Orthopaedics & Traumatology: Surgery & Research. 2013 Oct 1;99(6):S345-55.
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