Return to Physical Activity after Isolated Subtalar Arthrodesis

CATEGORY: Hindfoot INTRODUCTION/PURPOSE: Subtalar arthrodesis has been shown to provide reliable pain relief and deformity correction for a variety diagnoses including include primary arthritis, posttraumatic arthritis, inflammatory arthritis, talocalcaneal coalitions, and hindfoot deformity. However, the level of functional activity achievable following this procedure is unknown. The aim of this study was to assess physical activity and functional outcomes in patients following isolated, primary subtalar arthrodesis. METHODS: A retrospective review of isolated primary subtalar fusions was performed. Inclusion criteria were: age between 18 and 65, isolated primary subtalar fusion that achieved bony union, minimum 4 month radiographic follow up (XR or CT), and 1 year minimum questionnaire follow up. Patients who had neuromuscular diagnoses, adjacent joint arthritis, inflammatory arthritis, contralateral ankle or hindfoot pathology, significant medical comorbidities, or were treated under worker's compensation were excluded. The primary outcome measure was the Foot and Ankle Ability Measure. Additional patient reported outcomes included a novel functional assessment questionnaire, Coughlin Satisfaction Score, and a contralateral hindfoot comparison score. RESULTS: Patient reported outcome measures were collected from 15 (10 F, 5 M) patients at a median of 78 (49, 106) months following surgery. The median FAAM ADL subscore was 83.3 (71.4, 98.8) and the sports subscore was 59.4 (40.6, 87.5). The majority (58%) of patients maintained the same level of physical activity before and after surgery. Fewer patients were able to golf, rollerskate/ice skate, run, weightlift, or take aerobics/yoga after surgery. More patients were able to dance, hike, play tennis/pickleball, or walk for exercise. More patients were able to wear shoes without limitations and fewer patients required a brace or orthotics. Good and excellent outcomes were reported by 73% of the cohort. The median contralateral comparison score for the cohort was 90 (50, 100). CONCLUSION: Isolated subtalar arthrodesis can provide reliable pain relief and allow reasonable functional outcomes as demonstrated in this patient cohort. In general, most patients maintain their level of function and have fewer limitations with shoe wear. Select, higher impact activities may be more challenging for patients with a fused subtalar joint. These findings may be used to help surgeons appropriately counsel patients about expected postoperative physical activity following an isolated subtalar arthrodesis.