Treatment for arthritis of the Subtalar joint in the ankle

I have end-stage arthritis of the subtallular joint. Orthopedist adjusted my orthotics but the adjustment does not help much. I periodically have pain and stiffness in my ankle that limit my mobility. The Mayo Clinic doctor I was seeing has retired and did not refer me to anyone else. Have you considered total ankle replacement?

Is a fusion and ankle replacement the same? My arthritis is moderate right now. So, fusion or ankle replacement is not needed at this time. However, I want to do something now to prevent having to do either in the future.

No, fusion and ankle replacement are different. In a fusion, the surgeon uses rods to connect two or more bones. The surgery is done to stabilize the movement of bones in the ankle and prevent wear and tear caused by bones rubbing against one another due to the breakdown of cartilage in the joints. Total ankle replacement involves replacing the major joints in the ankle with artificial joints (like a knee replacement).
Since you have arthritis, probably the best way to avoid surgery is to follow the recommendations from reputable medical sources such as the Mayo Clinic or the American Arthritis Foundation: eat a healthy diet, maintain a healthy weight, and keep moving. Sometimes supplements such as glucosamine can help but there is mixed scientific evidence about their effectiveness.
Hope this helps,
Helen

P.S. Keep using the orthotics.

I had my left ankle fused in December of 2014 if you have any specific questions about fusion. I had end-stage arthritis with severe bone deformity from years of internal bleeding due to my genetic bleeding disorder called hemophilia. I was told a large factor in whether or not a replacement or fusion is best for you is based on how active you are. I was told it is the opposite of what you think, the more active you are the better a fusion is because it creates a stable joint that can take more weight and activity, whereas a replacement is a bit more limiting due to the fact that the components are so small and susceptible to failure. I can say, the recovery from an ankle fusion was long and arduous, but the end result has been a complete elimination of years of severe chronic pain and I find it to not limit almost nothing I do - except for running, which I no longer did anyways. Feel free to ask other questions about fusion, I'd be happy to answer them.

@bernard 53 I have found some websites you can Research http://www.preclinical co.uk/condition/subtler joint ,www.nccih.mh.gov/health/magnets. It's a degenerate condition of ankle from arthritis ,to be treated same way as you treat osteoarthritis ,heat,medicine muscle rubs ,glucosamine is recommended

Thank you for posting these links. I have been taking glucosamine for years as well as using both cold and hot packs. I also take a prescription NSAID. Unfortunately, because the ankles bear all of the body’s weight, end-stage arthritis can result in loss of mobility unless surgical treatment is used.

I am considering ankle surgery now. I want the surgery that ends with the best physical activity. I work outside around the house and play some doubles tennis. Is fusion better or is replacement better for an active guy?

Hello @gallagher17, welcome to Connect. Tough question, and one that would you should definitely ask your surgeon as well. In my personal experience, I was told by my surgeon that ankle replacements are better suited for less active, older adults. It was explained to me that because the pieces of an ankle replacement are so small, they have a higher probability of failure. However, I can tell you from experience of having an ankle fusion that your gait and ability to run will be limited as you will have very limited range of motion in that ankle. In fact, the movement you still have is the foot bones and not the ankle. The recovery is tough as well. It sounds like you are an active person, and the post-op recovery is a LOT of sitting around and waiting because you have to wait for the joints to fuse together properly. This even meant no upper body workouts because my surgeon and his team were concerned about blood clots forming in the ankle because you are so sedentary in your lower half and you have a large cast on with no way to be able to move blood out of your ankle if you increase your blood flow via workout.

@gallagher17, here are the things I considered when I finally made the choice to go with the fusion: The pain was so intense on a daily basis that I felt the choice was made for me, the arthritis I had in my ankle was so bad that my actual ankle bones were deformed to the point of already fusing on their own. It took about 18 months to find my "new normal," but, I can tell you that I have gone from being in perpetual pain and having the inability to walk a block to no pain at all in the ankle and no limiting distance as to how far I can go on it. I can go on walks with my wife now (although, I do have end-stage arthritis in my right ankle and will need to do it all over again). I now work out on my leg without limits. The only real noticeable thing is the inability to run as the ankle no longer hinges.

If you don't mind me asking, how is your pain? Do you have arthritis as well? Have you asked your surgeon or provider the benefit of each procedure? It's a tough decision, but ultimately, I think I made the right choice as I was no longer running anymore anyways, but I also have multiple joint issues that prevent me from doing so.

Thanks for the comments. I will make a decision soon. Need to get on without pain.

Justin, where did you have the procedure done?