Sinus Tarsi Syndrome

Anatomy

  • Funnel-shaped sinus
  • Laterally based, leading into narrower tarsal canal

Boundaries

  • Anterior: Talocalcaneonavicular joint
  • Posterior: Posterior facet subtalar joint
  • Inferior: Calcaneus and Extensor Digitorum Brevis (EDB)
  • Superior: Talus

Contents

  • Blood vessels supplying the talus
  • Intraosseous talocalcaneal ligament
  • Origin of inferior extensor retinaculum
  • Nerve branches

Aetiology

  • Nerve irritation, vascular engorgement resulting in pain
  • Possible causes:
    • Fibrous talocalcaneal coalition
    • Subtalar instability
    • Subtalar arthritis
    • Intraosseous ligament tear

Clinical Presentation

  • Usually a history of ankle injury
  • Pain over the lateral aspect of the hindfoot
  • Pain on varus tilt
  • Pain on uneven ground
  • 50% have ankle instability or pain

Imaging

X-ray (XR)

  • Broden’s view, Stress views & Lateral
  • Subtalar degenerative disease
  • Laxity on stress testing

MRI

  • Inflammation in the sinus tarsi
  • Intraosseous talocalcaneal ligament rupture

Management

  • Activity modification, NSAIDs, and rest
  • Steroid Injection
    • Usually effective for most patients
    • If ineffective, has diagnostic value
  • Surgical excision of tarsal sinus contents and debridement
  • Correction of underlying pathology, including:
    • Fibrous coalition
    • Instability
    • Subtalar arthritis
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