pathology: sinus tarsi syndrome

yogabook / pathology / sinus tarsi syndrom

Definition

Inflammation of the sinus tarsi, a depression between the talus and calcaneus. The sinus tarsi is formed by two grooves: the sulcus calcanei of the calcaneus and the sulcus tali of the talus. It narrows from lateral to medial. The interosseous talocalcaneal ligament, which stabilises the subtalar joint, runs through the tarsal sinus. The sinus tarsi overlaps with the canalis tarsi (ankle joint canal) or can be regarded as part of it. These structures divide the subtalar joint into an anterior and a posterior chamber. Acute supination trauma or iterated supination trauma damages the bifurcated ligament of the OSG as well as other soft tissues. The repeated maintenance of this irritation does not only cause pain, but also degeneration and scarring. As an experiment has shown, the feeling of instability caused by this, which
may be partly due to impaired proprioception of the tendons, is reduced by anaesthetising the area. 70% of those affected by sinus tarsi syndrome have a fibular capsular ligament rupture in the OSG or a disorder of the tibialis posterior, i.e. disorders of the movement dimension pronation–supination.

Cause

  1. Supinationstrauma
  2. Overuse
  3. Direct trauma
  4. Foot deformities
  5. Instabilities
  6. Ankle joint–Arthritides
  7. Standard variants of the bone shape
  8. Nerve compression syndrome in the tarsal sinus

Predisposing

  1. RA
  2. Gicht
  3. Bechterew

Diagnose

  1. palpatorily: Pressure soreness
  2. Painlessness test for local anaesthesia
  3. X-ray, sono, MRT if necessary

Symptome

  1. anterolateral strain pain at the tip of the malleolus lateralis
  2. Often: unstable feeling of the ankle
  3. Signs of inflammation
  4. Pain intensification due to inversion or eversion of the foot
  5. possibly rest pain

Complications

  1. Chronification of the pain phenomenon
  2. sporting restrictions
  3. Changes in gait pattern due to pain avoidance and its consequences
  4. Instability of the OSG
  5. Ankle joint arthrosis
  6. Nerve damage

Therapie

  1. Conservative if possible: PT, physical therapy, lymphatic drainage, NSAIDs
  2. Orthese
  3. Surgical intervention is rarely necessary

DD

  1. Coalitio calcaneonavicularis
  2. Coalitio talocalcanei
  3. Coalitio calcaneocuboidei
  4. Stress fractures of the calcaneus: in the corpus or at the anterior process (especially in runners)
  5. Joint damage after calcaneus–fractures
  6. osteophytes
  7. Neuropathies, such as radiculopathies