Download Sinus-Tarsi-Syndrome-Teaching-Pack

Sinus Tarsi Syndrome
Normal Anatomy
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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
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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
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Ligament sprains
Examination
Subjective
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Deep anterolateral ankle pain
History of single or repeated ankle sprain trauma
Reports a feeling of instability
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Aggravated by walking over uneven ground, stepping off a curb or running or sprinting
activities
Cutting and jumping on firm surfaces
Objective
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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
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Lidocaine injection
Broden stress view X-rays
Stress fluoroscopy
MRI
Management
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Goal is to restore stability to the subtalar joint
Treatment is similar to lateral ligament sprains and often treated at the same time
Conservative
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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
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Synovectomy of the subtalar joint
Ligamentous reconstruction
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References
(Helgeson 2009)
Helgeson, K. (2009). "Examination and Intervention for Sinus Tarsi Syndrome." N Am J Sports Phys
Ther 4(1): 29-37.
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