Subtalar joint instability: current clinical concepts

Human anatomy has been investigated for centuries and the subtalar joint is no exception. Rubin and Whitten [1] first theorized the specific clinical entity of STJ instability, though they were unable to demonstrate any cases in their patient population. It was not until almost 20 years later that their theory was proven. Although the classification of subtalar joint instability was formally described by Brantigan et al [2] in 1977, Chrisman and Snook [3] took note of it in 1969 when they identified three of seven patients with symptoms of STJ instability who were being treated for lateral ankle instability. In subsequent years many anatomic studies have strived to define which ligaments are most responsible for supporting the osseous structures that compose the talocalcaneal joint. Most investigators recognize the importance of the calcaneofibular ligament (CFL) and the interosseous-talocalcaneal (ITC) ligaments. In addition to this, a myriad of surgical reconstructions have been suggested, all aimed at restoring stability while decreasing the loss of function associated with sacrificing the peroneus brevis tendon by way of tenodesis.