Subtalar Joint Injection

Chronic capsulitis

Causes and findings:
• Trauma - usually after fracture or severe impaction injury, often many years later
• Overuse in the older obese
• Pain deep in medial and lateral sides of heel
• Painful and limited: passive adduction of the calcaneus

Equipment:
Syringe - 2ml
Needle - 23G 1.25 inches (30mm) blue
Kenalog 40 - 30 mg
Lidocaine - 1.25 ml 2%
Total volume - 2 ml

Anatomy:
The subtalar joint is divided by an oblique septum into anterior and posterior
portions. It is slightly easier to enter the joint just above the sustentaculum
tali, which projects a thumb's width directly below the medial malleolus.

Technique
• Patient lies on side with foot supported so that medial aspect of heel faces upwards
• Identify bump of sustentaculum tali
• Insert needle perpendicularly immediately above and slightly posterior to sustentaculum tali
• Deposit half solution here
• Withdraw needle slightly and angle obliquely anteriorly through septum into anterior compartment of joint space and deposit remaining solution here

Aftercare:
The patient should avoid excessive weight-bearing activities for at least 1 week. Orthotics and weight control are helpful in preventing recurrence.

Comments:
This is a difficult injection to perform due to the anatomical shape of the joint. It can be repeated at infrequent intervals if necessary.