The hindfoot is composed of three different joints in the back of the foot. These three bones are held together by a series of ligaments and together function to move the foot side to side. The main function of the hindfoot joint is to allow for the side to side motion (inversion/eversion) of the foot for accommodating uneven ground such as grass and gravel. Arthritis is when the cartilage is damaged or worn away and no longer provides the cushion to allow the smooth motion between the bones. Cartilage is unique in that there is no blood flow that provides nutrition, so that when injured it does not have the ability to repair itself very well, unlike bone. This inability to repair itself is why scientists and surgeons have a very difficult time in trying to restore large cartilage defects in the setting of arthritis. The most common reasons for hindfoot arthritis include: trauma (fractures/dislocations), deformity, autoimmune arthritis, and what is called idiopathic (no known cause - or wear and tear).
Diagnosing hindfoot arthritis begins with a thorough history, focusing on the location of the pain and what causes aggravation. In many patients the pain presents along the outside of the hindfoot. “Start up” pain occurs in the morning or when a patient has been in one position for a prolonged time such as sitting in a car. The joint becomes stiff and can hurt for the first few steps while the joint “loosens” up the joint. Although there is no perfect answer for this, some of the reason is felt to be that the joint lining called the synovium begins to produce joint fluid more when you are moving and this helps to minimize the pain after a few minutes. This may be why many patients with hindfoot arthritis prefer a little walking to standing in one place. Additionally, walking on flat surfaces is generally more comfortable than uneven ground. The physical exam is particularly focused on how the location of the pain - determining the affected joints. Additionally any deformity, such as a high arched foot or flatfoot is noted as this can impact the nonoperative and operative options. Xrays are taken to confirm the presence of arthritis and evaluate the biomechanical alignment of your foot and ankle. Additional testing such as a CT scan and MRI may be considered.
Treatment of hindfoot arthritis is focused on your needs based on your pain and desired level of activity. Non-surgical treatment focuses on minimizing the strain and stress across the hindfoot with the use of semi-rigid or rigid ankle braces. The braces cannot improve the lack of cartilage, however, can help to minimize your pain. Injections can help in many patients and provide relief, however, rarely are they able to provide a long-term solution in isolation. Injections can include steroid and in some cases PRP (platelet rich plasma) depending on the severity of the arthritis. Shoewear and activity modification can also help to minimize the stress across the joint and help to provide symptom relief and avoid surgery. In patients that do not obtain relief or the restrictions are not amenable or acceptable to their desired lifestyle or work demands, surgical options can be considered. In severe cases of arthritis of the hindfoot, the only operation that is effective is a fusion. There is no current replacement for the hindfoot like there is for the ankle. The fusion allows us to realign the joints of the foot to correct any deformity and one the bones are fused (the bones grow together after the surgery) - then there is no joint and the pain improves. In most cases of arthritis of the hindfoot, the motion is severely limited already, and most patients note a functional improvement with a better aligned foot and decrease in pain.
Our Published Literature Related to Arthritis of the Hindfoot
1. Triple Arthrodesis. Reconstructive Foot & Ankle Surgery: Management Of Complications. (2019) - Book Chapter
2. Tibiotalocalcaneal & Pantalar Arthrodesis. Reconstructive Foot & Ankle Surgery: Management Of Complications. (2019) - Book Chapter
3. Subtalar Arthrodesis. Reconstructive Foot & Ankle Surgery: Management Of Complications. (2019) - Book Chapter
4. Tarsal Coalition. Reconstructive Foot & Ankle Surgery: Management Of Complications. (2019) - Book Chapter
5. Cavus Foot Correction. Reconstructive Foot & Ankle Surgery: Management Of Complications. (2019) - Book Chapter
6. Complications Of Treatment Of Flatfoot. Reconstructive Foot & Ankle Surgery: Management Of Complications. (2019) - Book Chapter
7. Correction Of Flatfoot Deformity In The Adult. Reconstructive Foot & Ankle Surgery: Management Of Complications. (2019) - Book Chapter
8. Correction Of Flatfoot Deformity In The Child. Reconstructive Foot & Ankle Surgery: Management Of Complications. (2019) - Book Chapter
9. Disorders Of The Foot & Ankle. Miller’s Review Of Orthopaedics. (2019) - Book Chapter
10. Overview Of The Ankle & Foot. Essential Orthopaedics. (2019) - Book Chapter
11. Preoperative PROMIS Scores As A Predictive Method For Postoperative Success In Posterior Tibial Tendon Dysfunction Surgery. Foot & Ankle Orthopaedics. (2019)
12. Leg, Ankle, & Foot Diagnosis & Decision-Making. DeLee & Drez’s Orthopaedic Sports Medicine. (2018) - Book Chapter
13. Imaging Of The Foot & Ankle. DeLee & Drez’s Orthopaedic Sports Medicine. (2018) - Book Chapter
14. Did Failure Occur Because Of Medial Column Instability That Was Not Recognized, Or Did It Develop After Surgery? Foot & Ankle Clinics. (2017)
15. Adult-Acquired Flatfoot Deformity. European Journal Of Orthopaedic Surgery & Traumatology. (2017)
16. Role Of Spring & Deltoid Ligament Reconstruction For Adult Acquired Flatfoot Deformity. Techniques In Foot & Ankle Surgery. (2017)
17. General Principles. Passport For The Orthopedic Boards & FRCS Examination. (2015) - Book Chapter
18. Generalized Conditions. Passport For The Orthopedic Boards & FRCS Examination. (2015) - Book Chapter
19. Disorders Of The Foot & Ankle. Miller’s Review Of Orthopaedics. (2015) - Book Chapter
20. Hindfoot. Passport For The Orthopedic Boards & FRCS Examination. (2015) - Book Chapter
21. The Cavus Foot. Foot & Ankle Clinics. (2013)
22. Valgus Malalignment: What Joints To Address? Foot & Ankle International. (2012)
23. Arthritis Of The Foot & Ankle. Presentation, Imaging & Treatment Of Common Musculoskeletal Conditions. (2011) - Book Chapter
24. Tarsal Coalition. Presentation, Imaging & Treatment Of Common Musculoskeletal Conditions. (2011) - Book Chapter
25. Introduction To Magnetic Resonance Imaging Of The Foot & Ankle. Presentation, Imaging & Treatment Of Common Musculoskeletal Conditions. (2011) - Book Chapter
26. Novel Reconstruction Of A Static Medial Ligamentous Complex In A Flatfoot Model. Foot & Ankle International. (2010)
27. Malunion & Nonunion In Foot & Ankle Surgery. Foot & Ankle Specialist. (2010)
28. The Foot & Ankle. Sports Medicine & Arthroscopy Review. (2010) - Book Chapter
29. Correction Of Multiplanar Deformity Of The Foot & Ankle. Preface. Foot & Ankle Clinics. (2009)
30. Overview Of The Ankle & Foot. Essential Orthopaedics. (2009) - Book Chapter
31. Percutaneous Screw Configuration Versus Perimeter Plating Of Calcaneus Fractures: A Cadaver Study. Foot & Ankle International. (2008)
32. Ankle & Hindfoot Reconstruction: What Is New In Ankle Arthroplasty, Allograft, & Fusion. Current Opinion In Orthopaedics. (2004)
33. Hindfoot Arthrodesis For The Adult Acquired Flat Foot. Foot & Ankle Clinics. (2003)
