The subtalar joint is often forgotten when people present with ankle pain. Yet it’s a common site of fractures, sprains, and early arthritis — all of which cause ankle and foot pain. Treatment is complex and sometimes involves an ultrasound-guided subtalar joint injection. So, when and how should we perform one?
What is the subtalar joint?
The subtalar joint is complex — the calcaneus (heel bone) below and the talus above, held together by strong ligaments. The ankle joint above moves the foot up and down; the subtalar joint moves it inwards (inversion) and outwards (eversion). This lets you handle uneven ground without losing balance. You couldn’t run, jump, or dance properly without it.
What causes subtalar joint problems?
Because it’s vital to movement, the subtalar joint is vulnerable to wear and trauma:
Osteoarthritis
The cartilage wears away with age, causing inflammation and pain. Lifestyle factors — obesity, diabetes, high cholesterol — can worsen it.
Inflammatory arthritis
Immune-driven arthritis, such as rheumatoid arthritis or gout, can inflame and damage the joint.
Pes planus (flat foot)
When the arch collapses, it loads the subtalar joint, causing pain.
Tarsal coalition
A tarsal coalition — where two hindfoot bones are abnormally joined — alters movement and places abnormal forces on the subtalar joint, often leading to arthritis. It commonly becomes painful in teenagers around puberty.
Calcaneal (heel) fracture
A heel-bone fracture after a fall can involve the joint. If it heals in a poor position, abnormal forces lead to early arthritis and pain.
How do we diagnose subtalar joint pain?
Subtalar pain is typically deep and poorly localised — felt on the outer or inner ankle or heel, often worse when walking or running on uneven ground. We usually find the joint stiff and tender.
It can be confused with Achilles tendon pain, but Achilles tendon pain is more focal and increases with tendon loading, whereas subtalar pain doesn’t. Imaging — X-ray, ultrasound, and MRI — often confirms the diagnosis in combination, and blood tests can exclude inflammatory arthritis. A diagnostic subtalar joint injection helps confirm that the joint is the source of the pain.
We must exclude other causes of heel and ankle pain: tibialis posterior tendonitis, calcaneal stress fracture, Achilles tendonitis, heel bursitis, sinus tarsi syndrome, and tarsal tunnel syndrome.
How do we treat subtalar joint problems?
We start with simple measures: oral ibuprofen, ice, and orthotics. Physiotherapy is essential — improving calf and foot strength, balance, and foot-intrinsic strength.
When simple measures fail, a subtalar joint injection of cortisone can help. Occasionally, we use hyaluronic acid or PRP in the joint instead.
If everything fails, surgery — reshaping the bone (osteotomy) or fusing the joint — may help. But fusion costs you subtalar movement.
More on the ultrasound-guided subtalar joint injection
Because the joint is complex, we strongly recommend image guidance.
Injections were traditionally performed using X-ray (fluoroscopy), which meant radiation exposure, costly equipment, and no view of nearby nerves or vessels. Ultrasound-guided injection is now highly accurate, radiation-free, and can be performed in the clinic rather than in a surgical unit, keeping costs down. We direct the injection to the most painful part of the joint, medial, lateral, or posterior. The lateral approach is quickest, but all three approaches are accurate.
Subtalar joint injection cost
The cost depends on the injectable and the clinic. Dr Masci performs the procedure as a one-stop visit—assessment, diagnostic ultrasound, and injection—in a single appointment, with Chelsea being the most cost-effective location. Review the current fees here.
Frequently asked questions about subtalar joint injection
How long does a subtalar joint injection last?
A cortisone injection generally lasts 3–4 months. PRP or hyaluronic acid may last longer.
What is the evidence for a subtalar joint injection?
The evidence is limited, but encouraging. One study found that a cortisone injection for tarsal coalition (a cause of subtalar pain) delayed surgery for up to two years. Another, using three hyaluronic acid injections for subtalar arthritis, improved pain and function — walking distance increased from 770 metres to over 2,000 metres.
Does a subtalar joint injection hurt?
Generally not, with ultrasound guidance and local anaesthetic. There may be mild soreness for a day or two afterwards.
Which approach do you use — medial, lateral, or posterior?
Whichever reaches the most painful part of the joint. The lateral approach is usually quickest and easiest, but all three are accurate under ultrasound guidance, which lets us choose the best route for your foot.
Is a subtalar joint injection the same as an ankle injection?
No. The ankle joint sits above the subtalar joint and moves the foot up and down. They’re separate joints with separate injections — which is exactly why ultrasound guidance matters, to target the right one.
Final word from Sport Doctor London about subtalar joint injection
Like any joint, the subtalar joint can cause ankle pain — and it’s easily overlooked. Try simple treatments before riskier ones, such as injection or surgery. If you need an injection, choose a doctor experienced in subtalar joint injection under ultrasound guidance.
To book a one-stop subtalar joint assessment and injection in London, contact the team here or call +44 (0) 203 488 0350.
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