Subtalar bone block distraction arthrodesis

Subtalar arthrosis following a malunited intra-articular calcaneal fracture can be associated with impaired ankle function because of a dorsiflexed talus and anterior ankle pain owing to tibiotalar impingement and loss of height at the hindfoot. Distraction at the subtalar joint restores calcaneal height and talar inclination. However, the operation is technically demanding. An understanding of the biomechanics and attention to detail are important to avoid potential complications, such as varus malalignment in the hindfoot, sural neuralgia, wound failure, and late collapse. This paper describes the technique, pearls, and pitfalls.