Arthroscopic subtalar release of post-traumatic subtalar stiffness.
We describe an arthroscopic approach of subtalar release for post-traumatic subtalar stiffness that can allow early postoperative vigorous mobilization. The patient is placed in the lateral position. Subtalar arthroscopy is performed via the standard anterolateral portal at the angle of Gissane, the middle portal just distal and anterior to the tip of the lateral malleolus, and the posterolateral portal at the vertical limb of the old surgical scar, just above the posterosuperior tubercle of the calcaneus. Arthroscopic subtalar release is performed in stages. First, the fibrous bands at the sinus tarsi are debrided. The most lateral part of the interosseous talocalcaneal ligament is released. The dense fibrous tissue of the lateral subtalar gutter is then cleared. Most of the time, the subtalar motion gained at this stage is insignificant. At the second stage, the posterior capsule can be released and the fibrous tissue at the posterior corner of the joint can be debrided. Finally, the lateral subtalar capsule and lateral subtalar ligamentous structures are stripped from the lateral calcaneal cortical surface. Stripping should be done beyond the old surgical scar to release the adhesion of the surgical scar to the lateral calcaneal wall.