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Subtalar Distraction Arthrodesis
The subtalar joint plays a central role in adapting the foot to uneven ground by enabling pronation/supination and eversion/inversion. Pathologic conditions of the subtalar joint, such as inflammatory arthritis or a deformity induced by an acquired flatfoot, can be corrected with simple realignment and arthrodesis. The posttraumatic deformity induced by the typical joint-depression fracture of the calcaneus is more difficult to manage, however, because the calcaneus is wider but shorter than normal. Subtalar distraction arthrodesis is indicated for this deformity. Perhaps the biggest concerns with distraction arthrodesis are soft-tissue complications. Distraction stretches the skin, and delayed wound healing is common. The patient with impaired circulation or scarred and brittle soft tissue is at risk of devastating wound complications. Subtalar distraction arthrodesis is contraindicated in these cases. This chapter discusses the indications/contraindications, results, surgical procedure steps, and complications associated with subtalar distraction arthrodesis.