In a triple arthrodesis, which joint is fused first?

• A. Subtalar joint (STJ)
• B. Tibiotalar joint
• C. Talocalcaneal joint
• D. Calcaneocuboid joint

Answer: (A)

Fusing the subtalar joint first sets the hindfoot in the correct, stable position before addressing the other joints. The subtalar joint governs hindfoot varus/valgus and overall hindfoot alignment relative to the tibia. By fixing this joint first, you eliminate hindfoot motion and lock in a corrected hindfoot alignment, providing a reliable platform from which the remaining joints can be brought into proper, plantigrade alignment.

After the hindfoot is stabilized, the remaining joints—the midfoot/medial column and the lateral column—are fused in the corrected position to complete the triple fusion. Fusing a forefoot or forefoot-adjacent joint first risks losing or compromising alignment due to ongoing hindfoot motion, making the other fusions less predictable.

Thus, the usual sequence starts with the subtalar (talocalcaneal) fusion, followed by the other joints (talonavicular and calcaneocuboid) to achieve a stable, plantigrade foot.