Conservative Outcomes of Subtalar Dislocation: A Systematic Review and Meta-Analysis of the Current Literature.
Ahmed Bakr, Yusuf Yusuf, Marwan Tahoun et al.
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In 30 seconds
This systematic review and meta-analysis assessed outcomes after closed reduction and immobilisation of acute isolated subtalar dislocations. It included 10 case-series studies (9 retrospective and 1 prospective), comprising 201 feet. Pooled radiographic post-traumatic arthritis was 36% (95% CI: 18%-53%; I 2 = 43%), although structural changes often did not correspond to functional impairment. Functional outcomes were generally favourable for closed medial dislocations, while lateral injuries had poorer outcomes. Subtalar stiffness was common, avascular necrosis was rare, and subsequent fusion was uncommon.
Key findings
- Pooled radiographic post-traumatic arthritis occurred in 36% (95% CI: 18%-53%; I 2 = 43%).
- Reduced subtalar range of motion affected 42.8%-76.6% of patients in studies reporting it.
- Avascular necrosis occurred in 0.5%, and subtalar fusion was required in 4.2% of cases.
- Lateral dislocations had significantly worse outcomes than medial injuries.
Why it matters
The findings distinguish radiographic changes from patient function: arthritis was common, but many patients remained functionally well. They also highlight frequent loss of subtalar motion and poorer reported outcomes after lateral dislocation. These patterns can inform discussions of expected recovery while underscoring that the evidence base is limited and symptom severity was inconsistently reported.
What to keep in mind
All included studies were case series, mostly retrospective, and outcomes were clinically heterogeneous. Symptom severity was inconsistently reported.