Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 27, Issue 9, pp 2818–2830 | Cite as

Currently used imaging options cannot accurately predict subtalar joint instability

  • Nicola Krähenbühl
  • Maxwell W. Weinberg
  • Nathan P. Davidson
  • Megan K. Mills
  • Beat Hintermann
  • Charles L. Saltzman
  • Alexej BargEmail author



To give a systematic overview of current diagnostic imaging options and surgical treatment for chronic subtalar joint instability.


A systematic literature search across the following sources was performed: PubMed, ScienceDirect, and SpringerLink. Twenty-three imaging studies and 19 outcome studies were included. The Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS 2) tool was used to assess the methodologic quality of the imaging articles, while the modified Coleman Score was used to assess the methodologic quality of the outcome studies.


Conventional radiographs were most frequently used to assess chronic subtalar joint instability. Talar tilt, anterior talar translation, and subtalar tilt were the three most commonly used measurement methods. Surgery often included calcaneofibular ligament reconstruction.


Current imaging options do not reliably predict subtalar joint instability. Distinction between chronic lateral ankle instability and subtalar joint instability remains challenging. Recognition of subtalar joint instability as an identifiable and treatable cause of ankle pain requires vigilant clinical investigation.

Level of evidence

Systematic Review of Level III and Level IV Studies, Level IV.


Subtalar joint Subtalar instability Hindfoot instability Imaging Outcome 


Author contributions

NK: literature search, data extraction, and manuscript writing. MWW: literature search, data extraction, and manuscript writing. NPD: drawing of figures and manuscript writing. MKM: providing clinical cases (X-rays/MRI) and manuscript writing. BH: manuscript writing. CLS: manuscript writing. AB: literature search, data extraction, and manuscript writing.


Nicola Krähenbühl is currently receiving a grant from the Swiss National Science Foundation (SNF; grant number P2BSP3_174979) and Swiss Orthopaedics.

Compliance with ethical standards

Conflict of interest

Maxwell W. Weinberg, Nathan P. Davidson, Megan K. Mills, Beat Hintermann, Charles L. Saltzman, and Alexej Barg have no conflicts to declare.

Ethical approval

This article does not contain any studies with human participants or animal experiments performed by any of the authrors.


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Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2018

Authors and Affiliations

  • Nicola Krähenbühl
    • 1
  • Maxwell W. Weinberg
    • 1
  • Nathan P. Davidson
    • 1
  • Megan K. Mills
    • 2
  • Beat Hintermann
    • 3
  • Charles L. Saltzman
    • 1
  • Alexej Barg
    • 1
    Email author
  1. 1.Department of OrthopaedicsUniversity of UtahSalt Lake CityUSA
  2. 2.Department of Radiology and Imaging SciencesUniversity of UtahSalt Lake CityUSA
  3. 3.Department of OrthopaedicsKantonsspital BasellandLiestalSwitzerland

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