Hindfoot Arthritis
Which joints the hindfoot means
The hindfoot is the group of joints just below the ankle — principally the subtalar joint between the heel bone and the talus, and the two joints in front of it. Together they let the foot tilt side to side and adapt to uneven ground. The ankle itself provides up-and-down motion; the hindfoot provides the rest.
How it presents
Hindfoot arthritis causes deep pain below and just in front of the outer ankle bone, and it is characteristically worse on uneven surfaces — grass, gravel, sloped ground — while level pavement may be tolerable. Stiffness after sitting is common, and the ankle region often looks swollen without an obvious cause.
Because the pain sits close to the ankle, it is frequently assumed to be ankle arthritis. Distinguishing the two matters, because the treatments are different.
Why it develops
The usual causes are a previous fracture of the heel bone or the talus, long-standing deformity such as a collapsed arch that has held the hindfoot tilted for years, and inflammatory arthritis. It can also follow a fusion elsewhere in the foot or ankle, as the adjacent joints take on more work.
Diagnosis
Weightbearing X-rays come first, and CT is often added because the hindfoot joints are curved and overlap on plain films. A diagnostic injection into a specific joint is one of the most useful tests available: if numbing that joint relieves the pain, it identifies the source.
Treatment
Non-surgical treatment aims to reduce the motion and load passing through the arthritic joints — a stiff-soled or rocker-bottom shoe, custom orthotics, an ankle brace, activity modification, anti-inflammatories, and cortisone injections.
When those stop working, fusion of the affected joint is the reliable surgical answer. Because the hindfoot joints contribute relatively little to walking on level ground, fusing one is generally well tolerated, and pain relief is dependable once the bone has healed. If the hindfoot sits out of alignment, the correction is done at the same time — a fusion in a poor position will not serve you well.
