Introduction The sinus tarsi is a poorly understood area and a common source of lateral hindfoot pain.
The sinus tarsi is a poorly understood area and a common source of lateral hindfoot pain. The sinus tarsi’s bony borders include the neck of the talus and the most anterior superior portion of the calcaneus. Within the sinus tarsi there are five ligaments and a section of adipose tissue.
The primary ligament structures include the cervical ligament (CL), the interosseous talocalcaneal ligament (ITCL), and the extensor retinaculum. The sinus tarsi is considered a region of the subtalar joint. The primary role of the sinus tarsi is stabilize the hindfoot in inversion and eversion.
Etiologies of pain within the sinus tarsi region are not well understood, but typically occur after trauma that leads to tearing of the CL and ITCL. After tearing of the intrinsic ligaments of the subtalar joint, which include the CL and ITCL, the subtalar joint will have excess inversion and eversion. The excess motion leads to subtalar joint fibrosis and synovitis.
Ligamentous anatomy of the subtalar joint Diagnosis Providers typically consider sinus tarsi syndrome as a source of pain when there is lateral hindfoot pain to palpation in the area of the sinus tarsi. After ankle trauma, a patient can tear the ITCL, which may lead hindfoot instability. On physical exam, reproduction of excessive medial shift of the calcaneus can also aid in diagnosis of sinus tarsi syndrome.
Palpation of the sinus tarsi Diagnosis is difficult, as plain film radiographs cannot make the diagnosis alone. MRI can help aid in making the diagnosis. MRI findings that are consistent with sinus tarsi syndrome are tearing of the interosseous talocalcaneal ligament, cervical ligament, synovial thickening, and sinus tarsi fat signal change.
If you are experiencing symptoms that may be related to the sinus tarsi syndrome, it is important to see a sports medicine physician. Early evaluation and treatment typically lead to better outcomes. Do not ignore pain or symptoms that are limiting your activity.
*This article is for educational purposes only and does not substitute for professional medical advice. Always consult a qualified healthcare provider.*
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