Variations of anatomical elements contributing to subtalar joint stability: intrinsic risk factors for post-traumatic lateral instability of the ankle?

Ankle sprains are frequently followed by chronic lateral instability, often with talar hypermobility. This might be due to subtalar instability. Among intrinsic risk factors, anatomical variants are generally overlooked. In the subtalar region, anatomical variation is particularly frequent. On the talus as well as on the calcaneus, the anterior articular facets may be missing or fused with the medial facets, giving rise to three subtalar joint configurations: a three-joint configuration, a fused configuration with a relatively large anteromedial joint, and a two-joint configuration without anterior joint. Osteometry was performed on these joint facets (134 calcanei, 122 tali), demonstrating significant differences in the surface of these configurations and the existence of a supplementary supporting surface with grossly transverse orientation in the three-joint configuration. There are also several variants of stabilizing ligaments within the sinus tarsi. Some of these configurations might expose to increased risk of associated subtalar lesions, resulting in subtalar instability. A systematic look for these variants is recommended in order to evaluate the associated risk factors, eventually resulting in a better understanding, prevention and cure of sequellae.