Abstract
Foot pain is common in rheumatoid arthritis (RA), from forefoot involvement in early RA to later involvement of the hind foot. Foot and ankle involvement can lead to reduced walking distance and affect quality of life1. The prevalence of hind foot pain was estimated at 17% in early RA and up to 52% in patients with established RA2. Left untreated, inflammation of the subtalar joint can lead to progressive eversion of the joint, posterior tibial tendon tendinopathy, and collapse of the medial arch3. Clinically, pain from the joint is often reported in the lateral hind foot. Anatomically, the talus forms the mechanical gateway from the leg to the foot4. Its superior surface articulates with the fibula and tibia. A complex articulation is formed between the talus, calcaneus, and navicular bone inferiorly and anteriorly4,5. The subtalar joint is functionally a single joint that, anatomically, is divided into an anterior part, the talocalcaneonavicular joint or anterior subtalar joint (ASTJ) and a posterior part, the talocalcaneal joint or posterior subtalar joint (PSTJ)4,5. The ASTJ is formed by the navicular bone and the head of the talus anteriorly and the anterior and middle facets of the talus and the calcaneus (sustentaculum tali) inferiorly (Figure 1a and 1b). The spring ligament supports the joint inferiorly. The talonavicular joint and anterior talocalcaneal joint therefore form a continuity and together will be referred to as the ASTJ4,5. The ASTJ is separated from the PSTJ by the sinus tarsi and tarsal canal with several strong ligaments within the sinus tarsi. The PSTJ consists of the posterior facets of the talus and the calcaneus4,5. It is … Address correspondence to Dr. G.S. Kaeley, 653-1 West Eighth St., LRC 2nd Floor L-14, Jacksonville, Florida 32209-6561, USA. E-mail: drgurj{at}gmail.com
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