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Sinus Tarsi Syndrome Normal Anatomy • Articulation of the talus and calcaneus (subtalar joint) across anterior, middle and posterior facets • Stability provided by various ligaments • Extrinsic • Calcaneofibular ligament • Deltoid ligament • Intrinsic • Talocalcaneal ligament • Interosseuous ligament • Cervical ligaments Normal Anatomy • 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 Subjective Examination • Deep anterolateral ankle pain • History of single or repeated ankle sprain trauma • Reports a feeling of instability • Aggravated by walking over uneven ground, stepping off a curb or running or sprinting activities • Cutting and jumping on firm surfaces Objective Examination • 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 Investigation • 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 • • • • Orthotics NSAID’s Ice Massage • Restore Normal Range of Movement • Ankle • Massage • Joint mobilisation • Joint manipulation • Restore Normal Muscle Activation • Evertors • Invertors • Intrinsic Foot Muscles • Restore Dynamic Stability • Proprioceptive Training • Sport Specific Training Plan B • Synovectomy of the subtalar joint • Ligamentous reconstruction References • Helgeson, K. (2009). "Examination and Intervention for Sinus Tarsi Syndrome." N Am J Sports Phys Ther 4(1): 29-37.
