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 damage
Sudden stop after a jump or fall

6. 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

7. 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

8. Further Investigation
Lidocaine injection
Broden stress view X-rays
Stress fluoroscopy
MRI

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

10. Conservative Reduce pain and inflammation
Orthotics
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):