What is Subtalar Instability

Subtalar instability is a condition in which the subtalar joint is unstable. Your subtalar joint is where your upper ankle bone (talus), your heel bone (calcaneus), and the bone in the front of your foot (navicular) meet.

This condition may make your ankle roll or give way often, especially when you walk or run on an uneven surface.

What are the causes?

This condition happens when there is a stretch or a tear in the strong bands of tissue that connect your ankle bones together (ligaments). The most common cause of this condition a severe ankle sprain or multiple ankle sprains that have not healed properly. This condition may also be caused by dislocating the subtalar joint. This can happen if your foot is twisted away from your ankle with severe force.

What increases the risk?

This condition is more likely to develop in people who participate in sports in which there is a risk of spraining an ankle, such as sports that require jumping, running, and quick direction changes. These include:

• Trail running.
• Basketball.
• Baseball.
• Tennis.
• Football.
• Soccer.

What are the signs or symptoms?

Symptoms of this condition include:

• Rolling your ankle often.
• Swelling.
• Pain.
• Bruising.
• Tenderness.
• Feeling wobbly or unsteady on your foot.
• Difficulty walking on uneven ground or in the dark.

How is this diagnosed?

This condition can be diagnosed based on:

• Your symptoms.
• Your medical history.
• A physical exam.
• Imaging tests, such as:
  • X-rays.
  • A CT scan to check for bone damage.
  • MRI to check for ligament damage.
  • An ultrasound.

During your physical exam, your health care provider may compare the movement of your unstable ankle to the movement of your other ankle.

How is this treated?

Treatment for this condition may include:

• Not putting any body weight on your ankle for several days.
• Wearing a removable boot, brace, or splint for ankle support.
• Wearing supportive shoes or shoe inserts.
• Taking anti-inflammatory pain medicine.
• Physical therapy. This involves doing calf stretching, ankle strengthening, and balancing exercises.
• Returning gradually to full activity.
• Surgery to repair damaged ligaments.

Usually, surgery is only needed if you have severe instability or if other treatments have not worked.

Follow these instructions at home:

If you have a boot, brace, or splint:

• Wear it as told by your health care provider. Remove it only as told by your health care provider.
• Loosen it if your toes tingle, become numb, or turn cold and blue.
• If it is not waterproof:
  • Do not let it get wet.
  • Cover it with a watertight covering when you take a bath or a shower.
• Keep it clean.
• Ask your health care provider when it is safe to drive if you have a boot, brace, or splint on your foot.

Managing pain, stiffness, and swelling

• Take over-the-counter and prescription medicines only as told by your health care provider.
• If directed, apply ice to the injured area:
  • Put ice in a plastic bag.
  • Place a towel between your skin and the bag.
  • Leave the ice on for 20 minutes, 2–3 times a day.
• Move your toes often to avoid stiffness and to lessen swelling.
• Raise (elevate) the injured area above the level of your heart while you are sitting or lying down.

Activity

• Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.
• Do not use your ankle to support (bear) your full body weight until your health care provider says that you can.
• Do not do any activities that make pain or swelling worse.
• Do exercises as told by your health care provider.

General instructions

• Wear supportive shoes or inserts as told by your health care provider.
• Keep all follow-up visits as told by your health care provider. This is important.

How is this prevented?

• Warm up and stretch before being active.
• Cool down and stretch after being active.
• Give your body time to rest between periods of activity.
• Make sure to use equipment that fits you.
• Be safe and responsible while being active to avoid falls.
• Wear supportive footwear that is appropriate for your athletic activity.
• Avoid athletic activities that cause ankle pain or swelling.
• If you start a new athletic activity, start it gradually so you can build up your strength and flexibility.
• If you sprain your ankle and continue to have symptoms of a sprained ankle, such as pain or swelling, for more than 4 weeks, see your health care provider.

Contact a health care provider if:

• Your condition is not getting better.
• Your symptoms are getting worse.
• After your health care provider says that it is okay to start using your ankle again, you cannot put weight on your ankle without feeling pain.

Subtalar Instability Rehab

Ask your health care provider which exercises are safe for you. Do exercises exactly as told by your health care provider and adjust them as directed. It is normal to feel mild stretching, pulling, tightness, or discomfort as you do these exercises, but you should stop right away if you feel sudden pain or your pain gets worse. Do not begin these exercises until told by your health care provider.

Stretching exercises

These exercises warm up your muscles and joints and improve the movement and flexibility of your ankle. These exercises also help to relieve pain, numbness, and tingling.

Exercise A: Gastroc and soleus, standing

1. Stand on the edge of a step on the balls of your feet. The ball of the foot is on the walking surface, right under the toes. Hold onto the railing for balance if needed.
2. Slowly lift your uninjured foot, allowing your body weight to press your left / right heel down over the edge of the step. You should feel a stretch in your left / right calf.
3. Hold this position for __________ seconds.
4. Repeat this exercise with a slight bend in your left / right knee.

Repeat __________ times with your left / right knee straight and __________ times with your left / right knee bent. Complete this stretch __________ times per day.

Strengthening exercises

These exercises build strength and endurance in your ankle. Endurance is the ability to use your muscles for a long time, even after they get tired.

Exercise B: Heel walking (dorsiflexion)

1. Walk on your heels for __________. Keep your toes as high as possible.

Repeat __________ times. Complete this exercise __________ times per day.

Exercise C: Toe walking (plantar flexion)

1. Walk on your toes for __________ . Keep your heels as high as possible.

Repeat __________ times. Complete this exercise __________ times per day.

Exercise D: Eversion

1. Sit on the floor with your legs straight out in front of you.
2. Loop a rubber exercise band around the ball of your left / right foot. The ball of your foot is on the walking surface, right under your toes.
3. Hold the ends of the band in your hands, or secure the band to a stable object.
4. Slowly push your foot outward, away from your other leg.
5. Hold this position for __________ seconds.
6. Slowly return your foot to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

Balance exercises

These exercises improve your balance. Balance is important in improving the stability of your foot and ankle and in preventing falls. Do these exercises in your brace if told by your health care provider.

Exercise E: Tandem walking

Do this exercise in a hallway or room that is at least 10 ft. (3 m) long.

1. Stand with one foot directly in front of the other. You can use the walls to help you balance if needed, but try not to use them for support.
2. Slowly lift your back foot and place it directly in front of your other foot.
3. Continue to walk in this heel-to-toe way for __________.

Repeat __________ times. Complete this exercise __________ times per day.

Exercise F: Plantar flexion/dorsiflexion 1

You will need a balance board for this exercise. Ask your health care provider where you can get a balance board or how you can make one.

1. Stand on a non-carpeted surface near a countertop or wall.
2. Step onto the balance board so your feet are hip-width apart.
3. Keep your feet in place and keep your upper body and hips steady. Using only your feet and ankles, tip the board forward and backward so the board silently taps the floor. Do not let the board forcefully hit the floor.

Repeat __________ times, pausing from time to time to hold a steady position. Complete this exercise __________ times a day.

Exercise G: Plantar flexion/dorsiflexion 2

You will need a balance board for this exercise. Ask your health care provider where you can get a balance board or how you can make one.

1. Stand on a non-carpeted surface near a countertop or wall.
2. Step onto the balance board so your feet are hip-width apart.
3. Keep your feet in place and keep your upper body and hips steady. Using only your feet and ankles, tip the board forward and backward. Do not let the board hit the floor at all.

Repeat __________ times, pausing from time to time to hold a steady position. Complete this exercise __________ times a day.

Exercise H: Inversion/eversion 1

You will need a balance board for this exercise. Ask your health care provider where you can get a balance board or how you can make one.

1. Stand on a non-carpeted surface near a countertop or wall.
2. Step onto the balance board so your feet are hip-width apart.
3. Keep your feet in place and keep your upper body and hips steady. Using only your feet and ankles, tip the board from side to side as far as you can, alternating between tipping to the left and to the right. If you can, tip the board so it silently taps the floor. Do not let the board forcefully hit the floor.

Repeat __________ times, pausing from time to time to hold a steady position. Complete this exercise __________ times a day.

Exercise I: Inversion/eversion 2

You will need a balance board for this exercise. Ask your health care provider where you can get a balance board or how you can make one.

1. Stand on a non-carpeted surface near a countertop or wall.
2. Step onto the balance board so your feet are hip-width apart.
3. Keep your feet in place and keep your upper body and hips steady. Using only your feet and ankles, tip the board from side to side, alternating between tipping to the left and to the right. Do not let the board hit the floor at all.

Repeat __________ times, pausing from time to time to hold a steady position. Complete this exercise __________ times a day.