There are many ways to help a bad foot ‘quarterback’

Conway McLEAN, DPM

For those of you who happened upon this column recently, I wanted to offer my condolences. You may have learned more than you ever thought possible about the sub-talar joint: that most critical of foot joints in allowing proper foot function. This particular joint, found just below the ankle, is vital to the important task of propelling us forward, keeping us upright, enabling us to walk.

Hopefully you gained some glimpse into how this occurred, and what this joint does for us in the course of our daily lives. But what kind of problems develop when this structure does not function correctly and what can be done to reduce those effects?

Take Rob, for example. A middle-aged fellow in generally good health, he suffered from chronic back pain, which he considered a curse of sorts. Nearly everything he wanted to do, needed to do, or had to do, involved his back, and that meant pain.

Weekly visits to his chiropractor kept him going and reduced his pain, but he still had significant discomfort on a daily basis. A steroid injection into his back had helped him only temporarily, but it was a pair of prescription foot orthotics which eventually resulted in a significant reduction in his daily pain levels. With time, he found he needed only rare chiropractic visits to stay comfortable.

Then there is the case of Susan, a recent retiree who finally found herself with the time to pursue the many activities she had been dreaming of for years. Many of these involved exploring the great outdoors and the many wonders of local nature. Unfortunately, walking over uneven ground reliably caused her ankle pain, and this was the type of surface found on most trails.

Pain was becoming commonplace for Susan (as well as frustration). A course of physical therapy helped noticeably with her pain levels….until the next hike took place. The use of some pre-fabricated arch supports, along with a new pair of hiking boots recommended by her podiatrist, surprisingly relieved the majority of her pain.

These are just two examples of the many conditions which can result from a malfunctioning sub-talar joint. There are many, including plantar fasciitis, big toe joint arthritis, bone spurs on the arch, Achilles tendonitis, and others. The list goes on and on, all traced back to a malfunctioning subtalar joint. Some others were listed in the previously-referenced article.

At this juncture, I presume you are demanding answers to the question of what can be done for bad sub-talar joint mechanics. This must be your lucky day because I have the answers!

There are many treatments for sub-talar joint mechanics that can be performed on your own, one caveat being how does one know which are appropriate? The claims of many product manufacturers would leave one to believe theirs can cure world hunger. Some simpler options include various exercises, which, at the very least, are healthy, regardless of whether they help with one’s discomfort.

For example, strengthening the muscles running to the sides of the foot may help if your sub-talar joint is mis-aligned and allowing excessive collapse of the arch. (Remember pronation?)

Better shoes are one obvious method of giving the foot and ankle better support. For some with a mild problem, this is enough to provide relief. Naturally, shoes are “generic” so if you have a foot type which is not far from the norm, a change to a different shoe may improve things significantly. For most, this helps slightly, but not enough. The concept of getting a better foundation can be extended to the use of some kind of padding, most commonly under the arch. Typically, these products are only minimally beneficial, but are not firm enough or specific enough to do more than reduce pain marginally.

Naturally, a prescription arch support, fashioned from an exact copy of your foot, can do more. Surprisingly, the results of foot orthotic therapy are mixed. Many people find them uncomfortable or of little benefit. This is the predictable result of a poor prescribing process. Making a copy of the foot is a critical step, yet some methods of obtaining this copy are known to provide poor results (but are more convenient). When done correctly, these in-shoe supports are quite comfortable and can provide wonderful results. Predictably, there are few if any complications.

Surgical options exist for sub-talar joint problems. The oldest is to simply fuse the joint, meaning there will be no motion. But the movement produced by this joint is essential for normal body mechanics, which is what gives u`s the ability to walk, to stand, to run. Removing the motion of this joint will reliably lead to problems, be it knee arthritis or arch pain, or some other chronic musculoskeletal condition. This kind of procedure should be saved for a “worst-case scenario,” a last-ditch effort to relieve pain.

Perhaps the most exciting development in the treatment of these problems is a stent inserted into this joint. It prevents the joint from moving out of position, which is a common cause of fallen arches. This stent is essentially a joint blocker, meaning it prevents extra, abnormal motion of the sub-talar joint. This reduces the stress placed on various soft tissue structures, which is what leads to pain. The stent is placed minimally invasively, and recovery is easy. The benefits can be surprising.

Another option is termed reconstructive surgery, in which various bones are cut and tendons moved. Essentially, the individual is given an arch. This can eventually be effective in relieving pain, although the recovery is lengthy, and often painful. There are many opportunities for complications in bone surgery this complex. Recovery is difficult since no weight bearing is possible on the surgical limb for many weeks. Because of the amount of trauma required, swelling can be persistent. Still, it can potentially provide real improvement.

If musculoskeletal pain is reducing your activity levels, have it checked out. Being active is critically important for heart health, metabolism, circulation, a healthy body weight, and certainly not the least important, quality of life. Your discomfort may be due to a problem with your sub-talar joint. As should be clear, there are lots of treatment options: it’s simply a matter of knowing which one is best for you.

Editor’s note: Dr. Conway McLean is a physician practicing foot and ankle medicine in the Upper Peninsula, with an upcoming move of his Marquette office to the downtown area. McLean has lectured internationally on wound care and surgery, being double board certified in surgery, and also in wound care. He has a sub-specialty in foot-ankle orthotics. Dr. McLean welcomes questions or comments