1 Sinus Tarsi Syndrome

2 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

3 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

4 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

5 Mechanism of Injury Traumatic Single or repeated ankle sprains damageSudden stop after a jump or fall

7 Objective ExaminationPain 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

8 Further InvestigationLidocaine injection Broden stress view X-rays Stress fluoroscopy MRI

9 Management Goal is to restore stability to the subtalar jointTreatment is similar to lateral ligament sprains and often treated at the same time

10 Conservative Reduce pain and inflammationOrthotics NSAID’s Ice Massage Restore Normal Range of Movement Ankle Joint mobilisation Joint manipulation Restore Normal Muscle Activation Evertors Invertors Intrinsic Foot Muscles Restore Dynamic Stability Proprioceptive Training Sport Specific Training

11 Plan B Synovectomy of the subtalar joint Ligamentous reconstruction

12 References Helgeson, K. (2009). "Examination and Intervention for Sinus Tarsi Syndrome." N Am J Sports Phys Ther 4(1):