Definition
Pain at lateral aspect sinus tarsi
Anatomy
Osseous canal between talus and calcaneum
- anterior to posterior facet
- 45 degrees from posteromedial to anteriolateral
Contents
- artery of the sinus tarsi
- interosseous talo-calcaneal ligament (ITCL)
- cervical ligament
- nerve endings
Etiology
Flat foot and overpronation
Sprain or inversion injuries in athletes
Pathology
Unclear
- synovitis
- partial tear interosseous TC / cervical ligament
- postraumatic arthrofibrosis / scarring
- subtalar instability
Symptoms
Pain at lateral aspect ankle below lateral malleolus
- with uneven ground
- with running
Examination
Tenderness sinus tarsi - soft indentation below and anterior to lateral malleolus
Pain with eversion / inversion subtalar joint
Cortisone injections
Diagnostic
MRI
Edema / scarring / synovial thickening / fat alterations in sinus tarsi
Tears of interosseous / cervical ligament
Subtalar arthroscopy
- 118 ankles with sinus tarsi syndrome and lateral ankle instability
- subtalar arthroscopy
- 69% tear of ITCL on MRI
- 90% tear of ITCL on arthroscopy
- isolated lateral ankle instability 36%), subtalar instability 25%, combined 38%
Nonoperative management
Usually very effective
Options
Rest
NSAIDS
Subtalar joint manipulation
Injections
Orthotics to stabilise subtalar and correct overpronation
Operative management
Options
Subtalar arthroscopy and debridement +/- lateral ligament reconstruction (for instability)
ITCL reconstruction
Subtalar arthroscopy and debridement
Technique
Arthroscopic techniques sinus tarsi debridement PDF
Youtube arthroscopic sinus tarsi debridement video
Results
- 33 cases of subtalar arthroscopy for sinus tarsi syndrome
- debridement
- partial tear ITCL 88%, synovitis 55%, partial tear of the cervical ligament 33%, arthrofibrosis 24%, soft-tissue impingement 21%
- 88% good or excellent results
Interosseous Talocalcaneal Ligament Reconstruction
Results
- arthroscopic gracilus autograft ITCL reconstruction
- 25 patients at minimum 6 year follow up
- 88% good or excellent return to sports outcome
- 16% mild to moderate ROM limitation