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Subtalar Joint

The subtalar joint is a complex anatomical structure located between the talus and calcaneus bones in the foot.
It plays a crucial role in foot and ankle biomechanics, allowing for inversion, eversion, and other movements essential for gait and stability.
Understading the subtalar joint's structure and function is key for managing conditions like ankle sprains, flatfoot, and other musculoskeletal disorders affecting the lower extremity.
This MeSH term provides a comprehensive overview of the subtalar joint's anatomy, physiology, and clinical relevance to guide healthcare professionals and researchers in their work.

Most cited protocols related to «Subtalar Joint»

1
Evaluating Muscle-Driven Simulations for Locomotion
We used our refined model to track the same experimental data, and thus generate a new set of muscle-driven simulations during pedalling, walking and running. Data from the pedalling simulations were averaged over five crank cycles, between consecutive top-dead centres, and data from the walking and running simulations were averaged over five gait cycles, between consecutive ipsilateral foot strikes. The simulated kinematics (from CMC) tracked the smoothed kinematics (from RRA) with maximum RMSEs that were less than 5.3° and 0.5 cm for rotational DoFs and pelvis translations, respectively; maximum errors were less than 10.2° and 0.86 cm, respectively (Fig. 4). These errors are comparable to those obtained using the intermediate model and are slightly higher than the recommended tolerances for kinematics obtained using CMC 16 ; however, the highest errors were at the subtalar joint, and rotations at this joint are difficult to quantify given the resolution obtained from conventional motion capture 25 . The time-varying hip, knee and ankle kinematics obtained using CMC compared very favourably with the input kinematics, providing confidence that our simulations reproduced the subjects' movement dynamics (Fig. 4).
To evaluate our refined model, we compared the results predicted using the intermediate and refined models as follows. For pedalling, we compared the model-based muscle activations with the subject's measured EMG data. For walking and running, EMG data were not collected as part of the larger study; hence, we compared the predicted muscle activations with previously-reported EMG data during walking and running at equivalent speeds 14 (link),24 . EMG data of each muscle was normalised to the average peak activation predicted using the two models. We also compared the net total, passive and active joint moments during pedalling, walking, and running — as predicted using both models — by summing the moments generated by the individual muscles in each model.
Lai A.K., Arnold A.S, & Wakeling J.M. (2017). Why are antagonist muscles co-activated in my simulation? A musculoskeletal model for analysing human locomotor tasks. Annals of biomedical engineering, 45(12), 2762-2774.
Publication 2017
Immune Tolerance Joints Joints, Ankle Knee Joint Methamphetamine Movement Muscle Tissue Pelvis Subtalar Joint
2
Detailed Musculoskeletal Model of Lower Limbs
The musculoskeletal model was implemented in the AnyBody Modeling System (v. 7.0.1, AnyBody Technology A/S, Aalborg, Denmark) based on the detailed muscular geometry of the cadaveric dataset TLEM 2.0 [27 (link)].
The model consists of a simplified upper body (lumbar region, rigid trunk, neck, and head) and 11 segments representing the lower limbs: pelvis, right and left femurs, patellas, shanks, tali, and feet. Each lower limb comprises four joints: the hip joint is modelled as a 3 degrees of freedom (DOF) ball-and-socket, while knee, talocrural and subtalar joints are modelled as 1-DOF hinges. Additionally, the position of the patella is defined as a function of the knee flexion angle, therefore not introducing additional DOFs.
The model contains 55 muscle actuators in each leg, divided into 169 elements in accordance with the original TLEM dataset [27 (link),28 (link)]. Coordinates of insertion and origin points of the single elements were extracted from the contours of measured attachment areas. The muscle elements were modelled with a simple muscle model represented by constant strength actuators.
De Pieri E., Lund M.E., Gopalakrishnan A., Rasmussen K.P., Lunn D.E, & Ferguson S.J. (2018). Refining muscle geometry and wrapping in the TLEM 2 model for improved hip contact force prediction. PLoS ONE, 13(9), e0204109.
Publication 2018
Biological Models Femur Foot Gomphosis Head Hip Joint Human Body Joints Knee Joint Lower Extremity Lumbar Region Muscle Rigidity Muscle Tissue Neck Patella Pelvis Subtalar Joint Talus
3
Measuring Static Foot Characteristics in Research
Our work focused on static foot measures commonly used in our clinical laboratory, specifically FPI-6, ND, RFA, and MLAA. This was a pragmatic decision, based on measures that the team have experience using and a review of the foot classification literature. The right foot was assessed for all participants, only one foot was assessed due to the conceptual and statistical concerns about pooling data from both feet highlighted by Menz [21 (link)]. One investigator with three years experience of static foot assessment conducted all testing (BL), with a research assistant recording test scores to help blind the rater and minimise bias within the data. Participants were tested on two occasions within the same test session, with at least ten minutes rest period between measures. Participants were asked to assume a relaxed standing position in double limb support, looking straight ahead with their arms by their sides. The order of testing was consistent throughout the study and measures were conducted in the following order: FPI-6, ND, RFA, and MLAA. Skin markings made on the foot and shank for the ND, RFA and MLAA measures were removed between test and retest.
The FPI-6 was conducted following a standard protocol [22 ]. Talar head congruency, lateral malleoli curvature, calcaneal inversion/eversion, talonavicular bulging, medial longitudinal arch congruency and forefoot to rearfoot abduction/adduction were measured. Each component was scored on a scale ranging from -2 to +2 and the cumulative score used to define foot type. Foot type was classified according to normative values with scores of ≥ 8 representing a pronated foot type, 0 to 5 a neutral foot and ≤ -1 a supinated foot [23 (link)].
The RFA was measured in accordance with Jonson and Gross [24 (link)]. Briefly, four locations were palpated and marked using a skin marker pen (Fig. 1a). These were: (1) the base of the calcaneus; (2) the Achilles tendon attachment; (3) the centre of the Achilles tendon at the height of the medial malleoli; (4.) the centre of the posterior aspect of the shank 15 cm above marker three. The RFA was measured using a goniometer. The arms of the goniometer were aligned with the line connecting marker one and two (line 1) and the other arm with the lines connecting marker three and four (line 2). The RFA was measured as the acute angle between the projection of line one and line two. RFA ≥ 5° valgus represented a pronated foot type, 4° valgus to 4° varus a neutral foot and ≥ 5° varus a supinated foot [24 (link)].

a Anatomical locations for rearfoot angle calculation, 1 = base of calcaneus, 2 = Achilles tendon attachment, 3 = centre of Achilles tendon at the height of the medial malleolus and 4 = centre of the posterior aspect of the shank 15 cm above marker 3. b Anatomical landmarks used to calculate the MLAA; MM = medial malleolus, NT = navicular tuberosity, MH = first metatarsal head and γ = MLAA

For the MLAA, the midpoint of the medial malleolus, the most prominent aspect of the navicular tuberosity and the most medial prominence of the first metatarsal head were palpated and marked using a skin marker pen (see Fig. 1b) [12 (link)]. The MLAA was measured using a goniometer with the centre of the goniometer aligned with the navicular mark and the arms aligned to connect the navicular mark with the medial malleolus and first metatarsal head markings. The obtuse angle was recorded as the MLAA. MLAA < 130° represented a pronated foot type, 130° to 150° a neutral foot type and > 150° a supinated foot type [12 (link)].
ND was determined following the protocol of Brody [25 (link)]. Initially the most prominent aspect of the navicular tuberosity was palpated and marked with a skin marker pen. A piece of card (14.8 x 4.2 cm) was placed next to the medial aspect of the foot and the height of the navicular in a relaxed standing position marked on the card. The foot was then manipulated into subtalar joint neutral as determined by congruence of the talar head, and the process outlined above repeated. ND was recorded as the difference in navicular height between STJN and relaxed standing. ND > 9 mm represented a pronated foot type, 5 to 9 mm a neutral foot and < 5 mm a supinated foot [23 (link)].
Langley B., Cramp M, & Morrison S.C. (2016). Clinical measures of static foot posture do not agree. Journal of Foot and Ankle Research, 9, 45.
Publication 2016
Anatomic Landmarks Arm, Upper Blindness Calcaneus Clinical Laboratory Services Foot Head Inversion, Chromosome LINE-1 Elements Metatarsal Bones Navicular Bone of Foot Skin Subtalar Joint Tendon, Achilles
4
Navicular Drop Measurement During Treadmill Walking
The foot length was measured with a ruler from the most posterior aspect of calcaneus to the tip of the longest toe. The foot length ranged from 21 – 31 cm (table 1). Custom made flat markers with a diameter of 13.5 mm made from reflective 3 M scotch tape were used. The markers were placed while participants were seated with the subtalar joint in a neutral position. Neutral position of the subtalar joint was defined as the position where talus could be palpated equally on the medial and lateral side of the foot [18 (link)]. An experienced clinician placed the markers with adhesive tape on (i) the navicular tuberosity, (ii) medial aspect of calcaneus 2 cm above the floor and 4 cm from the most posterior aspect of the calcaneus, and (iii) medial aspect of first metatarsal head 2 cm above the floor (figure 1).
The participants were instructed to walk bare-footed on a treadmill at self-selected speed. After an accommodation period of six minutes [32 (link)], recordings were carried out for 20 sec.
A 2D motion capture system (VSA) was used to measure ND during walking [33 ]. It consists of a digital video camera (Basler Scout; Basler AG, Ahrensburg, Germany) with a 12 mm lens sampling at 86 Hz. The camera was mounted perpendicular to the sagittal plane at the level of the foot on the treadmill. ND was defined as the maximal vertical movement of the navicular bone from heel strike to the minimal height between the navicular tuberosity and the floor. It was calculated as the perpendicular distance between the marker on the navicular tuberosity and the line between the markers on calcaneus and first metatarsal head. The distance between the floor and the line in standing position between the markers on calcaneus and first metatarsal were added afterwards. ND was calculated as the mean of 20 consecutive steps.
The system was found highly reliable in a test/retest pilot study with ICC values for ND at 0.95 (within day) and 0.94 (between days).
Nielsen R.G., Rathleff M.S., Simonsen O.H, & Langberg H. (2009). Determination of normal values for navicular drop during walking: a new model correcting for foot length and gender. Journal of Foot and Ankle Research, 2, 12.
Publication 2009
Calcaneus Fingers Foot Head Heel Lens, Crystalline Metatarsal Bones Movement Navicular Bone of Foot Ocular Accommodation Subtalar Joint Talus
5
Dynamometer-Assisted Foot-Tibia Angle Adjustment
To manipulate the angle between the foot sole and the tibia (foot-plate angle), a custom designed hand-held dynamometer was used, that allows individual correction for non-rigid varus/valgus foot forefoot (for details see [14 (link)]). The purpose of applying such individual changes to the foot plate was to limit as much as possible variation between individual subjects in movement executed, due to variation in participation of the subtalar joints in the dorsal and plantar flexion movements imposed via the hand held dynamometer.
To obtain such limitation, the subtalar joints need to be stabilized as much as possible: This was obtained by applying the following corrections:
(1) The calcaneus is rotated to the neutral position within the frontal plane. This in fact brings the calcaneus to a neutral position under the tibia.
(2) Adduction of the forefoot is applied with the aim of bringing the calcaneus midline to pointing between the 2nd and 3rd ray of the forefoot. This will cause the caput of the talus to protrude under the skin. If the talocalcaneal joint is sufficiently stable the skin over the most medial part of the talus will wrinkle on imposing dorsal flexion.
(3) If the talocalcaneal joint is not sufficiently stable as yet, the fore- and midfoot are supinated until sufficient stability is reached.
The dynamometer for measurements of externally applied moments [Nm] is equipped with an inclinometer (goniometer that measures angle with the horizontal) (Figure 1A). If care is taken to position the tibia horizontally by supporting the lower leg on the table, the inclinometer indicates the angle between foot plate and tibia (φfp) within the sagittal plane (i.e. angles of dorsal and plantar flexion, with positive values referring to dorsal flexion conditions).
Foot plate angle data were collected during exertion of a moment of: a) -4 Nm, b) 0 Nm, and c) +4 Nm, respectively, as well as moments data collection at angles intermediate between a) and b); and c) and d), respectively.
All such dynamometer measurements were repeated five times and for each repetition the plateau values of moments applied were held for five seconds [14 (link)]. The mean of five repetition values at the end of the five seconds holding time was taken as a data point for a subject.
Huijing P.A., Bénard M.R., Harlaar J., Jaspers R.T, & Becher J.G. (2013). Movement within foot and ankle joint in children with spastic cerebral palsy: a 3-dimensional ultrasound analysis of medial gastrocnemius length with correction for effects of foot deformation. BMC Musculoskeletal Disorders, 14, 365.
Publication 2013
ARID1A protein, human Calcaneus Foot Head Leg Movement Muscle Rigidity Neoplasm Metastasis Skin Subtalar Joint Talus Tibia

Most recents protocols related to «Subtalar Joint»

1
Navicular Height Changes in Neutral Position
ND quantifies changes in navicular height in millimeters between two standing positions (Sell et al., 1994 (link)). Participants stood barefoot and the vertical distance from the most prominent palpable portion of the navicular tuberosity to the ground of each foot was measured with a ruler. Participants then stood with the subtalar joint in its neutral position, achieved by supinating and pronating the foot until the assessor could palpate the medial and lateral talar heads equally. The measurements were taken twice on each foot and the average value was recorded. From our pilot study, the intrarater reliability was found to be excellent (intraclass correlation [ICC] (3,2)=0.97).
Engkananuwat P, & Kanlayanaphotporn R. (2023). Gluteus medius muscle strengthening exercise effects on medial longitudinal arch height in individuals with flexible flatfoot: a randomized controlled trial. Journal of Exercise Rehabilitation, 19(1), 57-66.
Publication 2023
Feelings Foot Head Navicular Bone of Foot SELL protein, human Subtalar Joint
2
Ankle Fusion: Outcomes and Complications
The primary outcomes of this study were complications, percentage of patients achieving bony fusion, and time to bony fusion. Complications were divided into major and minor complications. Major complications consisted of symptomatic nonunion, asymptomatic nonunion, tibiotalar pseudoarthrosis, intraoperative fracture, and deep wound infection. Minor complications consisted of discomfort of the osteosynthesis, exostosis, screw loosening, nonclinical subtalar pseudoarthrosis, and superficial surgical site infection. Bony fusion was defined as time to achieve bony union as described by each article, respectively, or fusion of both the tibiotalar and subtalar joint.
Lameire D.L., Abdel Khalik H., Del Balso C., Daniels T, & Halai M. (2023). Transportal Tibiotalocalcaneal Nail Ankle Arthrodesis: A Systematic Review of Initial Series. Foot & Ankle Orthopaedics, 8(1), 24730114231156422.
Publication 2023
Bones Exostoses Fracture, Bone Fracture Fixation, Internal Patients Pseudarthrosis Subtalar Joint Surgical Wound Infection Temporal Bone Wound Infection
3
Arthroscopic TTC Nail Fusion Protocols
A systematic search of 3 databases (the Medical Literature Analysis and Retrieval System Online (Medline), the Excerpta Medica Database (Embase), and Web of Science) and manual search of references was performed through April 4, 2022, by 2 reviewers (DLL and HAK) for literature related to arthroscopy in the context of TTC nail ankle fusion. The search terms included tibiotalocalcan*, arthrodesis, fusion, and arthroscopy. The complete search strategies can be found in Appendix 1. The inclusion criteria for this review were (1) TTC fusion using an intramedullary rod, (2) arthroscopy or the use of minimally invasive arthroscopic portals to prepare the tibiotalar and/or subtalar joint, (3) studies available in English, (4) studies including at least 5 patients, (5) outcomes data provided, (6) 18 years and older, and (7) all levels of evidence. Exclusion criteria consisted of (1) open TTC nail fusion, (2) cadaveric studies, (3) biomechanical studies, (4) no follow-up/outcomes data reported, (5) pediatric population, and (6) systematic reviews. Both arthroscopic (using an arthroscope in particular) and arthroscopic portal (creating portals and using other adjuncts such as fluoroscopy and curettes) joint preparation prior to TTC nailing were included in this study because of the similar small incisions and minimal soft tissue disruption associated with the procedure. For the purposes of this review, both minimally invasive techniques using an arthroscope, or arthroscopic portals with fluoroscopy will be referred to as “transportal TTC nailing.”
Lameire D.L., Abdel Khalik H., Del Balso C., Daniels T, & Halai M. (2023). Transportal Tibiotalocalcaneal Nail Ankle Arthrodesis: A Systematic Review of Initial Series. Foot & Ankle Orthopaedics, 8(1), 24730114231156422.
Publication 2023
Arthrodesis Arthroscopes Arthroscopy Fluoroscopy Joints Joints, Ankle Nails Patients Subtalar Joint Tissues
4
3D Foot Scanning and Customized Foot Orthoses
A 3D scan of the right foot of a healthy male with a rectus foot type (shoe size: 44 EUR), held in subtalar joint neutral position using Root et al. [28 ] method, was performed using Podform3D Mobile Application (Podform3D, Montréal, Canada) based on the iPhone TrueDepth camera. The foot scan was exported as a stereolithography (STL) file. The scanned foot was processed using Podform3D CAD Software and then sent to the 3D printer. FOs were printed by Podform 3D in Polynylon-11 using an HP Multi Jet Fusion 3D printer, a powder bed fusion technology subcategory. Two models of FOs were used in this study and were chosen based on the tissue stress model [15 (link)] and subtalar joint axis location and rotational equilibrium theory of foot function (19)‘s principles: (1) without extrinsic additions (minimalist FO (mFO)), and (2) with forefoot-rearfoot posts and a 6o medial wedge (FO6MW) (see Fig. 1). For each model, three shell thicknesses (2.6 mm, 3.0 mm, and 3.4 mm) were manufactured for a total of six FOs samples. All FOs had the same geometry (width, length and arch height). The only differences between experimental conditions were their thickness and the presence or absence of forefoot and rearfoot posts with a 6o medial wedge:

Condition #1: mFO, thickness of 2.6 mm.

Condition #2: mFO, thickness of 3.0 mm.

Condition #3: mFO, thickness of 3.4 mm.

Condition #4: FO6MW, thickness of 2.6 mm.

Condition #5: FO6MW, thickness of 3.0 mm.

Condition #6: FO6MW, thickness of 3.4 mm.

A FO without extrinsic additions (top), B FO with rearfoot and forefoot posts and a 6o medial wedge (top), C FO without extrinsic additions (side), D FO with rearfoot and forefoot posts and a 6o medial wedge (side), E FO without extrinsic additions (bottom), F FO with rearfoot and forefoot posts and a 6o medial wedge (bottom)

Pelaez A.S., Farahpour N., Griffiths I.B, & Moisan G. (2023). Thick shells and medially wedged posts increase foot orthoses medial longitudinal arch stiffness: an experimental study. Journal of Foot and Ankle Research, 16, 11.
Publication 2023
ARID1A protein, human Epistropheus Foot Males Powder Stereolithography Subtalar Joint Tissues Tooth Root
5
Reconstructive Osteotomy Evaluation
The efficacy of the multiple reconstructive osteotomy was assessed by comparison between various measurements preoperatively and during the mean time of 3.04 ± 1.21 years (95% CI, 2.17–3.91 years) follow‐up period. The functional results were evaluated with the American Orthopedic Foot and Ankle (AOFAS) ankle/hindfoot scale. The measurements of Böhler's angle, calcaneus‐talus angle, and talocalcaneal height were performed on pre‐ and postoperative lateral radiographs, while the aligned relationship of the calcaneal tuberosity was compared on pre‐ and postoperative axial radiographs. Postoperative clinical examination was focused on the range of motion at the ankle and subtalar joints, which was reflected by active motion of inversion and eversion of the patients.
Wang B., Guan X., Hu Y., Jiang G., Lin Q., Ye J., Xiang D, & Yu B. (2023). Multiple Reconstructive Osteotomy Treating Malunited Calcaneal Fractures Without Subtalar Joint Fusion. Orthopaedic Surgery, 15(3), 810-818.
Publication 2023
Calcaneus Foot Inversion, Chromosome Joints, Ankle Osteotomy Patients Physical Examination Reconstructive Surgical Procedures Subtalar Joint Talus X-Rays, Diagnostic

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1
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More about "Subtalar Joint"

The subtalar joint, also known as the talocalcaneal joint, is a crucial component of the human foot and ankle.
This complex anatomical structure lies between the talus and calcaneus bones, playing a vital role in foot and ankle biomechanics.
The subtalar joint allows for essential movements like inversion, eversion, and other motions that are crucial for gait and overall stability.
Understanding the subtalar joint's structure and function is paramount for healthcare professionals and researchers, as it is integral to managing a variety of musculoskeletal conditions affecting the lower extremity.
These include ankle sprains, flatfoot (pes planus), and other disorders that can impact the foot and ankle.
Comprehensive studies utilizing advanced imaging techniques, such as those found in Mimics 15.0, Somatom Definition, and Mimics v20, have provided valuable insights into the subtalar joint's anatomy and biomechanics.
Additionally, statistical analysis tools like SPSS Statistics 24, SPSS Statistics v22, and SPSS version 25 have been instrumental in quantifying and understanding the functional aspects of this joint.
Finite element analysis software, such as Abaqus 6.14, has also been employed to simulate and analyze the mechanical stresses and strain patterns within the subtalar joint, further enhancing our understanding of its biomechanical properties and behavior.
By leveraging these powerful tools and methodologies, healthcare professionals and researchers can gain a deeper understanding of the subtalar joint, ultimately leading to more effective prevention, diagnosis, and treatment of related musculoskeletal conditions.
This knowledge is crucial for optimizing patient outcomes and improving overall lower extremity health and function.