Special Kaiser section| Volume 47, ISSUE 3, P191-198, May 2008

Download started.


Posterior Bone Block Distraction Arthrodesis of the Subtalar Joint: A Review of 22 Cases

Published:March 10, 2008DOI:
      Twenty-two patients underwent a posterior bone block distraction arthrodesis of the subtalar joint between 1999 and 2006. The indication for surgery was loss of heel height, subtalar joint arthrosis, decreased talar declination with associated tibiotalar impingement, insufficient Achilles tendon function, malalignment of the rear foot, and pain with ambulation. There were 11 male and 11 female patients with a mean age of 46.7 years (range 20 to 71). The mean follow-up period was 27.3 months (range 12 to 63.9 months). Radiographic analysis revealed a mean increase in heel height of 6.09 mm (P = .0001), 5.83° (P = .12) of lateral talocalcaneal angle, 5.5° (P = .06) of talar declination, and 5.23° (P = .07) of calcaneal inclination. The talo-first metatarsal angle increased an average of 4.5° (P = .18). There was a 95.5% union rate. Postoperative complications included nonunion in 1 patient, subsidence of graft (collapse) in 1 patient, wound dehiscence in 3 patients, painful hardware in 7 patients, sural neuritis in 1 patient, superior cluneal nerve dysfunction in 1 patient and one mild varus malunion. Posterior bone block distraction arthrodesis can be successfully used to restore heel height, realign the foot, and decrease the morbidity associated with late complications of calcaneal fractures, as well as, nonunion and/or malunion following subtalar joint arthrodesis, Charcot neuroarthropathy, and avascular necrosis of the talus. Level of Clinical Evidence: 4.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to The Journal of Foot and Ankle Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Amendola A.
        • Lammens P.
        Subtalar arthrodesis using interposition iliac crest bone graft after calcaneal fracture.
        Foot Ankle Int. 1996; 17: 608-614
        • Baravarian B.
        Block distraction arthrodesis for the treatment of failed calcaneal fractures.
        Clin Podiatr Med Surg. 2004; 21: 241-250
        • Carr J.B.
        • Hansen S.T.
        • Benirschke S.K.
        Subtalar distraction bone block fusion for late complications of os calcis fractures.
        Foot Ankle. 1988; 9: 81-86
        • Burton D.C.
        • Olney B.W.
        • Horton G.A.
        Late results of subtalar distraction fusion.
        Foot Ankle Int. 1998; 19: 197-202
        • Chan S.C.
        • Alexander I.J.
        Subtalar arthrodesis with interposition tricortical iliac crest graft for late pain and deformity after calcaneus fracture.
        Foot Ankle Int. 1997; 18: 613-615
        • Chen Y.J.
        • Huang T.J.
        • Hsu K.Y.
        • Hsu R.W.
        • Chen C.W.
        Subtalar distractional realignment arthrodesis with wedge bone grafting and lateral decompression for calcaneal malunion.
        J Trauma. 1998; 45: 729-737
        • Clare M.P.
        • Lee 3rd, W.E.
        • Sanders R.W.
        Intermediate to long-term results of a treatment protocol for calcaneal fracture malunions.
        J Bone Joint Surg. 2005; 87A: 963-973
        • Myerson M.
        • Quill Jr, G.E.
        Late complications of fractures of the calcaneus.
        J Bone Joint Surg. 1993; 75A: 331-341
        • Zion I.
        • Shabat S.
        • Marin L.
        • London E.
        • Matan Y.
        • Howard C.B.
        • Nyska M.
        Subtalar distraction arthrodesis using a ramp cage.
        Orthopedics. 2003; 26: 1117-1119
        • Bibbo C.
        • Anderson R.B.
        • Davis W.H.
        Complications of midfoot and hindfoot arthrodesis.
        Clin Orthop Relat Res. 2001; 391: 45-58
        • Bednarz P.A.
        • Beals T.C.
        • Manoli 2nd, A.
        Subtalar distraction bone block fusion: an assessment of outcome.
        Foot Ankle Int. 1997; 18: 785-791
        • Trnka H.J.
        • Easley M.E.
        • Lam P.W.
        • Anderson C.D.
        • Schon L.C.
        • Myerson M.S.
        Subtalar distraction bone block arthrodesis.
        J Bone Joint Surg. 2001; 83B: 849-854
        • Rammelt S.
        • Grass R.
        • Zawadski T.
        • Biewener A.
        • Zwipp H.
        Foot function after subtalar distraction bone-block arthrodesis.
        J Bone Joint Surg Br. 2004; 86B: 659-668
        • Steel M.W.
        • Johnson K.A.
        • Dewitz M.A.
        • Ilstrup D.M.
        Radiographic measurements of the normal adult foot.
        Foot Ankle. 1980; 1: 151-158
        • Gallie W.E.
        Subastragalar arthrodesis in fractures of the os calcis.
        J Bone Joint Surg. 1943; 25: 731-736