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Sinus Tarsi Syndrome

The sinus tarsi is an anatomical space bounded by the talus and calcaneum, the talocalcaneonavicular joint anteriorly and posterior facet of the subtalar joint posteriorly. It is medially continuous with the much narrower tarsal canal. 

The sinus tarsi contains the cervical ligament and the three roots of the inferior extensor retinaculum. 

The tarsal canal contains the interosseous talocalcaneal ligament and the deep and intermediate roots of the inferior extensor retinaculum. 

Both the sinus and the canal contain blood vessels - which are important for the nutrition of the talus - and nerves. The extensor digitorum brevis and bifurcate ligament lie anterior to the sinus tarsi.

The term "sinus tarsi syndrome" was first applied in O'Connor in 1958 to a syndrome of post-traumatic lateral hindfoot pain and instability which was relieved by the injection of local anaesthetic into the sinus tarsi. 

The cause of pain has been postulated to be vascular engorgement or nerve irritation, both due to fibrosis.

Frey et al suggests (on the basis of arthroscopic examination) that sinus tarsi syndrome is an inaccurate diagnosis & there is usually an underlying abnormality:

  • interosseous talocalcaneal ligament tears
  • subtalar instability
  • osteochondral injuries of the subtalar joint
  • arthrofibrosis of the subtalar joint
  • degenerative disease of the subtalar joint
  • fibrous tarsal coalition
  • chronic inflammatory changes in the sinus tarsi connective tissues

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