Archives of Orthopaedic and Trauma Surgery

, Volume 131, Issue 6, pp 759–763 | Cite as

Accuracy of anterolateral versus posterolateral subtalar injection

  • Tanja Kraus
  • Nima Heidari
  • Paul Borbas
  • Hans Clement
  • Wolfgang Grechenig
  • Annelie-Martina Weinberg
Orthopaedic Surgery



Injections into the subtalar joint may be performed for diagnostic or therapeutic reasons. The anterolateral approach is most commonly utilised for this purpose. We evaluated the success of an intra-articular puncture by using the anterolateral in comparison to the posterolateral approach.


Sixty-eight cadaver adult feet were used for performing injections into the subtalar joint without fluoroscopic or ultrasound guidance. Methylene blue dye was infiltrated into 34 of the 68 subtalar joints through an anterolateral approach and into 34 through an posterolateral approach. An arthrotomy was then performed to confirm the placement of the dye within the joint.


Twenty-three of the anterolateral injections (67.6%) were successful as were 31 of 34 (91.2%) of the posterolateral. The posterolateral approach showed a greater accuracy with a statistically significance (p = 0.016).


Unintended peri-articular injection can cause complications and an unsuccessful aspiration can delay diagnosis. Comparing the anterolateral to the posterolateral approach with regards to the rate of successful intra-articular puncture of the subtalar joint without the use of imaging there is a greater accuracy with the PL with statistically significance.


Intraarticular Aubtalar Injection Anterolateral Posterolateral Subtalar joint Injection Approach Non-guided 



The authors would like to acknowledge the valuable contributions of Juergen Fechter and Dr. Bernhard Leipold for the assistance in statistics and in the preparation of the photos for this publication.

Conflict of interest



  1. 1.
    Bedi SS, Ellis W (1970) Spontaneous rupture of the calcaneal tendon in rheumatoid arthritis after local steroid injection. Ann Rheum Dis 29(5):494–495PubMedCrossRefGoogle Scholar
  2. 2.
    Bernau A, Heeg P (2003) Intraarticular punctures and injections: indications—prevention of infection—technique—complications. Orthopade 32(6):548–569 (quiz 569–570)PubMedGoogle Scholar
  3. 3.
    Beukelman T, Arabshahi B, Cahill AM, Kaye RD, Cron RQ (2006) Benefit of intraarticular corticosteroid injection under fluoroscopic guidance for subtalar arthritis in juvenile idiopathic arthritis. J Rheumatol 33(11):2330–2336PubMedGoogle Scholar
  4. 4.
    Bliddal H (1999) Placement of intra-articular injections verified by mini air-arthrography. Ann Rheum Dis 58(10):641–643PubMedCrossRefGoogle Scholar
  5. 5.
    Cahill AM, Cho SS, Baskin KM et al (2007) Benefit of fluoroscopically guided intraarticular, long-acting corticosteroid injection for subtalar arthritis in juvenile idiopathic arthritis. Pediatr Radiol 37(6):544–548PubMedCrossRefGoogle Scholar
  6. 6.
    Ford LT, DeBender J (1979) Tendon rupture after local steroid injection. South Med J 72(7):827–830PubMedCrossRefGoogle Scholar
  7. 7.
    Goossens M, De Stoop N, Claessens H, Van der Straeten C (1989) Posterior subtalar joint arthrography: a useful tool in the diagnosis of hindfoot disorders. Clin Orthop Relat Res 249:248–255PubMedGoogle Scholar
  8. 8.
    Gottlieb NL, Riskin WG (1980) Complications of local corticosteroid injections. JAMA 243(15):1547–1548PubMedCrossRefGoogle Scholar
  9. 9.
    Heidari N, Pichler W, Grechenig S, Grechenig W, Weinberg AM (2010) Does the anteromedial or anterolateral approach alter the rate of joint puncture in injection of the ankle? A cadaver study. J Bone Joint Surg Br 92(1):176–178PubMedCrossRefGoogle Scholar
  10. 10.
    Jackson DW, Evans NA, Thomas BM (2002) Accuracy of needle placement into the intra-articular space of the knee. J Bone Joint Surg Am 84-A(9):1522–1527PubMedGoogle Scholar
  11. 11.
    Jones A, Regan M, Ledingham J, Pattrick M, Manhire A, Doherty M (1993) Importance of placement of intra-articular steroid injections. BMJ 307(6915):1329–1330PubMedCrossRefGoogle Scholar
  12. 12.
    Mitchell MJ, Bielecki D, Bergman AG, Kursunoglu-Brahme S, Sartoris DJ, Resnick D (1995) Localization of specific joint causing hindfoot pain: value of injecting local anaesthetics into individual joints during arthrography. AJR Am J Roentgenol 164:1473–1476PubMedGoogle Scholar
  13. 13.
    Padeh S, Passwell JH (1998) Intraarticular corticosteroid injection in the management of children with chronic arthritis. Arthritis Rheum 41(7):1210–1214PubMedCrossRefGoogle Scholar
  14. 14.
    Phisitkul P, Junko J, Femino J, Saltzman C, Amendola A (2007) Technique of prone ankle and subtalar arthroscopy. Tech Foot Ankle Surg 6:30–37CrossRefGoogle Scholar
  15. 15.
    Phisitkul P, Tochigi Y, Saltzman CL, Amendola A (2006) Arthroscopic visualization of the posterior subtalar joint in the prone position: a cadaver study. Arthroscopy 22(5):511–515PubMedCrossRefGoogle Scholar
  16. 16.
    Pichler W, Clement H, Boldin C, Grechenig W, Tesch NP (2007) Primary transection of the superficial peroneal nerve resulting from a distal fibula fracture. J Orthop Trauma 21(3):212–214PubMedCrossRefGoogle Scholar
  17. 17.
    Ruhoy MK, Newberg AH, Yodlowski ML, Mizel MS, Trepman E (1998) Subtalar joint arthrography. Semin Musculoskelet Radiol 2(4):433–438PubMedCrossRefGoogle Scholar
  18. 18.
    Saifuddin A, Abdus-Samee M, Mann C, Singh D, Angel JC (2005) CT guided diagnostic foot injections. Clin Radiol 60(2):191–195PubMedCrossRefGoogle Scholar
  19. 19.
    Sethi PM, El Attrache N (2006) Accuracy of intra-articular injection of the glenohumeral joint: a cadaveric study. Orthopedics 29(2):149–152PubMedGoogle Scholar
  20. 20.
    Smith J, Finnoff JT, Henning PT, Turner NS (2009) Accuracy of sonographically guided posterior subtalar joint injections: comparison of 3 techniques. J Ultrasound Med 28(11):1549–1557PubMedGoogle Scholar
  21. 21.
    Taillard W, Meyer JM, Garcia J, Blanc Y (1981) The sinus tarsi syndrome. Int Orthop 5(2):117–130PubMedCrossRefGoogle Scholar
  22. 22.
    Thiel W (1992) The preservation of the whole corpse with natural color. Ann Anat 174(3):185–195PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Tanja Kraus
    • 1
  • Nima Heidari
    • 2
  • Paul Borbas
    • 3
    • 4
  • Hans Clement
    • 4
  • Wolfgang Grechenig
    • 4
  • Annelie-Martina Weinberg
    • 5
  1. 1.Pediatric Orthopedic Unit, Department of Pediatric SurgeryMedical University of GrazGrazAustria
  2. 2.Royal London Rotation, Royal London HospitalLondonUK
  3. 3.Division of General Surgery, Department of SurgeryMedical University of GrazGrazAustria
  4. 4.Department of TraumatologyMedical University of GrazGrazAustria
  5. 5.Department of Pediatric SurgeryMedical University of GrazGrazAustria

Personalised recommendations