There are three subtalar joints; anterior, middle and posterior.  Subtalar joint injections in clinical practice refer to the posterior subtalar joint.  Injections can be performed using ultrasound, fluoroscopy and CT, although ultrasound is less frequently performed.  In an end stage arthropathy where the joint is very narrow, intra-articular access can be challenging and CT can be useful in these cases.

Technical considerations include aiming to avoid the lateral tendons, peroneal longus and peroneal brevis, which will traverse the superior aspect of the posterior subtalar joint. 

The needle used in this procedure was a 25 gauge.  If intra-articular access is not initially successful, a smaller 27 gauge could be considered but they are less stiff and will bend easier.  A luer lock syringe is a must to prevent needle-syringe detachment.