Cold, damp weather has a funny way of revealing old injuries. Every winter I see a rise in patients coming in with painful, stiff feet and ankles – particularly those with arthritis in the hindfoot.
It’s that deep, dull ache that’s worse in the mornings, eases a bit as you move, then flares up again after a walk in the cold. Sound familiar?
Let’s talk about why this happens, what’s going on inside the foot, and most importantly, what you can do about it; from simple adjustments to footwear to surgical options that can make a world of difference.
The hindfoot is the back section of the foot – the bit that connects your ankle to the midfoot. It includes the talus (the bone that forms the lower part of the ankle joint) and the calcaneus, or heel bone. Between them sits the subtalar joint, which allows your foot to roll inwards and outwards – essential for walking on uneven ground and for shock absorption.
When arthritis affects the subtalar or talonavicular joints, the smooth cartilage that cushions movement becomes worn or damaged. Without that cartilage, bone rubs against bone, leading to stiffness, swelling, and pain.
Many patients tell me their foot feels fine in summer but “locks up” in winter. There’s actually some logic behind this.
Cold and damp conditions can cause the tissues around joints, particularly synovial fluid and tendons, to become less elastic. That means your joints feel stiffer, less lubricated, and slower to get going.
Research backs this up: around 70% of people with osteoarthritis report weather-related changes in symptoms, especially when temperatures drop or barometric pressure changes.
Although we can’t control the climate, understanding the triggers helps you plan ahead – and manage your condition more effectively.
Hindfoot arthritis isn’t just a problem for older adults. I see it in a wide range of patients, from retired walkers to active runners and even footballers.
The common causes include:
In my clinic, I’d say around 1 in 5 patients I see with chronic foot pain have some degree of hindfoot or subtalar joint arthritis – and the number seems to rise each year as people stay more active later in life.
Patients usually describe:
I often see people who say they’ve been “putting up with it” for years, thinking it’s just part of ageing – until the winter months make it unbearable.
Diagnosis starts with a good clinical assessment. I’ll often test how much movement there is through the subtalar joint – it should glide smoothly from side to side. Loss of that movement, with tenderness and swelling, is usually a telltale sign.
Imaging helps confirm it:
When symptoms are mild to moderate, conservative treatment can be highly effective. The goal is to reduce pain, improve mobility, and slow progression of joint damage.
Shoes make a huge difference. I often recommend stiff-soled walking shoes or trainers with a rocker-bottom sole, which reduce the need for painful side-to-side motion at the subtalar joint.
Custom orthotics can correct alignment and offload pressure points – particularly useful if your pain stems from flat feet or previous injury. I recently had a patient, a 62-year-old keen rambler, who could barely manage a 2-mile walk before pain kicked in. With the right orthotic inserts and supportive boots, she’s now comfortably hiking 6–8 miles again.
Switching to low-impact activities such as cycling, swimming, or using an elliptical trainer can maintain fitness without aggravating the joint. Even walking poles can reduce strain on uneven ground.
Physio focuses on strengthening surrounding muscles and improving balance. Gentle range-of-motion exercises help maintain mobility without overloading the joint.
Corticosteroid injections
A corticosteroid injection is essentially a strong, targeted anti-inflammatory medicine delivered directly into the painful joint.
By targeting the inflammation at its source, they can provide excellent pain relief, often for several months, and in some cases years.
They are especially effective during acute flare-ups, when inflammation within the joint is driving most of the pain. We will confirm this using MRI imaging prior to progressing with treatment.
Some patients only need one injection; others might benefit from occasional repeat injections during bad flare-ups.
Platelet-rich plasma (PRP) injections
For those looking for a more biological or ‘regenerative’ option, PRP injections are becoming increasingly popular. PRP is made from your own blood; a small sample is taken, spun in a centrifuge to concentrate the platelets, and inject the plasma back into the joint. Platelets are rich in growth factors, which may help calm inflammation and support tissue healing.
The evidence for PRP is still evolving, particularly for hindfoot and subtalar arthritis. Some patients report meaningful improvement, while others notice only mild or temporary benefit.
Anti-inflammatory medication
Anti-inflammatory tablets (NSAIDs) can also help settle symptoms during a flare-up. They aren’t a long-term fix, but they do a good job at reducing pain and swelling in the short term. They’re not suitable for everyone, particularly people with stomach, kidney or heart problems, so I always advise using them under guidance and for limited periods only.
Cold weather care matters. Keeping your feet warm, using thermal socks, and doing gentle mobility exercises before heading out can make a big difference.
Maintaining a healthy weight also reduces load through the hindfoot – if you have a high BMI, losing even 10% of your bodyweight can noticeably ease symptoms.
For some patients, no matter how supportive the footwear or how diligent the physio, the pain still limits everyday life. When arthritis becomes end-stage – where cartilage is completely worn away – surgery often becomes the most effective route forward.
During surgery, the damaged cartilage is removed, the bones are aligned, and small screws hold them together while they fuse.
Fusion surgery has a success rate of around 90 - 95% for pain relief and improved function. The trade-off is a small loss of side-to-side motion, but most patients find this barely noticeable compared to the improvement in comfort.
Recovery requires patience. You’ll typically be in a cast or boot for 6 - 8 weeks, keeping weight off the foot initially to allow the bones to fuse. Gradual weight-bearing starts once healing is confirmed on X-ray, followed by physiotherapy to restore strength and balance.
Most people return to comfortable walking by around 3 - 4 months, and to more active pursuits like hiking or golf by 6 - 9 months. One of my patients summed it up nicely:
“I’d forgotten what it felt like to walk without wincing. The surgery gave me my life back.”
That’s the sort of result that makes the decision worthwhile.
Living with hindfoot arthritis, especially through the cold, damp British winter – can be frustrating. The stiffness, the ache that creeps up when the temperature drops, the way uneven ground suddenly feels like a mountain. But the good news is there’s a lot we can do.
From the right footwear and orthotics to injections, physiotherapy, and surgical solutions, there’s a full spectrum of treatment options available to you.
The key is recognising when conservative measures have done all they can, and being open to surgery if that’s what’s needed to restore quality of life.
So, if your hindfoot pain is holding you back this winter, don’t just grin and bear it.
Book an assessment with me, and let’s get you moving comfortably again.
What exactly is subtalar (hindfoot) arthritis?
Subtalar arthritis is wear-and-tear (or inflammatory) damage to the cartilage and surfaces of the subtalar joint - the joint between the talus and calcaneus in the hindfoot. It causes deep pain in the heel/behind the ankle, stiffness when walking on uneven ground, and sometimes swelling.
Why does my hindfoot hurt more in cold and damp weather?
Many patients report weather-related worsening. Systematic reviews show a statistically significant association between weather factors (temperature, humidity, barometric pressure) and OA pain in many studies, although findings are not uniform across every paper. It’s reasonable to acknowledge the symptom pattern and advise practical measures (warmth, footwear, gentle mobilisation).
Can orthotics or special shoes really help?
Yes, supportive footwear, rocker-soled shoes and targeted orthoses can reduce painful subtalar motion and redistribute load across the foot. Clinical and biomechanical studies demonstrate reduced painful motion and symptomatic benefit in selected patients. Orthotics are a low-risk first line and often worth a trial.
Are injections (steroid or PRP) useful for hindfoot arthritis?
Corticosteroid injections often give meaningful short-term relief by reducing inflammation inside the joint. PRP has been investigated: meta-analyses and RCT data are mixed - some short-term improvements have been reported, but a high-quality RCT did not show significant benefit at 26 weeks for ankle OA. I will always discuss realistic expectations and evidence with you before we make a decision on treatment.
If I have surgery (subtalar fusion), what are realistic outcomes and recovery times?
Subtalar fusion is the standard for end-stage subtalar arthritis and has high rates of pain relief (many series report >85–90% good outcomes).
Expect a period of protected weight-bearing in a cast/boot for about 6 - 8 weeks, progressive physiotherapy, comfortable walking by 3 - 4 months and return to most activities (including light hiking/golf) by c. 6 - 9 months depending on individual healing.
Mr Martin Klinke is one of London’s most trusted, and experienced foot specialists. He performs many bunion surgeries each year, and is a highly skilled surgeon.
He offers this surgical treatment to private self-funded and insured patients at the Cleveland Hospital and the Cleveland Clinic in London.
You can find all his patient reviews here.
