Transcript Sinus-Tarsi-Syndrome-Handoutx

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
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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.