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Sinus Tarsi Syndrome Normal Anatomy Articulation of the talus and calcaneus across anterior, middle and posterior facets Stability provided by various ligaments o Extrinsic Calcaneofibular ligament Deltoid ligament o Intrinsic Talocalcaneal ligament Interosseuous ligament Cervical ligaments Space between the talus and calcaneus is the sinus tarsi space This space is filled with connective and adipose tissue richly innervated with mechanoreceptors and free nerve endings Important for proprioception Inferior extensor retinaculum lies over the lateral aspect of the sinus tarsi Pathology Instability of the subtalar joint due to laxity or rupture of the intrinsic ligaments of the subtalar joint Instability results in excessive supination and pronation movements Increases the stress through the sinus tarsi tissues resulting in synovitis, fibrotic tissue and chronic inflammation Mechanism of Injury Traumatic Single or repeated ankle sprains damage Sudden stop after a jump or fall Associated Pathologies Ligament sprains Examination Subjective Deep anterolateral ankle pain History of single or repeated ankle sprain trauma Reports a feeling of instability 1 Aggravated by walking over uneven ground, stepping off a curb or running or sprinting activities Cutting and jumping on firm surfaces Objective Pain on palpation of the sinus tarsi Pain over the sinus tarsi at end range plantarflexion with foot supination Subtalar instability Pain with rotational movements during single leg standing Further Investigations Lidocaine injection Broden stress view X-rays Stress fluoroscopy MRI Management Goal is to restore stability to the subtalar joint Treatment is similar to lateral ligament sprains and often treated at the same time Conservative Reduce pain and inflammation o Orthotics o NSAID’s o Ice o Massage Restore Normal Range of Movement o Ankle Massage Joint mobilisation Joint manipulation Restore Normal Muscle Activation o Evertors o Invertors o Intrinsic Foot Muscles Restore Dynamic Stability o Proprioceptive Training Sport Specific Training Plan B Synovectomy of the subtalar joint Ligamentous reconstruction 2 References (Helgeson 2009) Helgeson, K. (2009). "Examination and Intervention for Sinus Tarsi Syndrome." N Am J Sports Phys Ther 4(1): 29-37. 3