Sinus Tarsi Syndrome

[kennethckyuen]

Hi,

Just brainstorming. I am not sure if Sinus tarsi sydrome would impinge you but what I came across is an anterior glided talus over the malleolus. I did usually AP glide to the talus in supine, or MWM (please refer to Mulligan) or I even gave a distraction manipluation to the joint. Usually the impingement feeling would go away. Hope this could help a bit.
Additional Comment I forgot:
Hi,

Just brainstorming. I am not sure if Sinus tarsi sydrome would impinge you but what I sometimes came across is an anterior glided talus over the malleolus.

I usually AP glided to the talus in supine, or MWM (please refer to Mulligan) or a distraction manipluation to the joint. Usually the impingement feeling would go away. Hope this could help a bit.

[dibblego]

Thanks kennethckyuen. I shall consider your suggestion.

I have a steroid/anaesthetic injection today into the sinus tarsi. I've had no improvement. I am convinced that the impingement is further posterior along the subtalar joint -- perhaps even posterior to the lateral malleolus.

This is driving me crazy. I reviewed all my radiographic images and they all show a high signal in the area that I can feel through the skin which suddenly moves when producing the impingement (a "crack" sound). It is posterior to the lateral malleolus at the subtalar joint height level with my finger pushing inward toward the anterior. When dorsoflexing then everting, there is a very definite crunch sound and a sudden movement can be felt.

This is driving me crazy. *Twenty-three months* and I am so close to getting out of jail. I may just ask the surgeon to go in both anterior and posterior with his arthroscope -- anything to nail this problem -- whatever it is.

I can show the MR images if anyone is curious. Hints?

[physiofixme]

A local injection of anesthetic agent into the sinus tarsi is a great diagnostic tool. In sinus tarsi syndrome, this injection will relieve pain (albeit temporarily) Sometimes it's a process of elimination so if the injection didn't change your symptoms then in theory you can rule out sinus tarsi syndrome.

Also in answer to one of your queries: Sinus tarsi syndrome does often leave you with a stiff subtalar joint, however a stiff subtalar joint can be a symptom of other conditions as well.
Additional Comment I forgot:
Oh and by the way - the article that uses STS and lateral impingement interchangeably isn't correct. They are two different syndromes!! Oh the internet.........

[dibblego]

Yeah there has been no improvement at all. My symptoms don't align with sinus tarsi syndrome, more like lateral subtalar impingement. The joint is still popping and cracking every time I walk like it always has and my ROM is extremely limited.

I feel like it is more posterior along the subtalar joint than the sinus tarsi. I wish I could localise it and I hope my surgeon finds it. I may ask him to go in both anterior and posterior to the lateral malleolus -- find it at all costs as far as I am concerned.

[dibblego]

Holy Schmoly I am such an idiot! I have a subluxed peroneal tendon! Now I am scared.

[physiofixme]

Ouch!! Are you going to have the tendon surgically repaired??

[dibblego]

I guess I am -- not sure what technique is the best these days. My surgeon doesn't know yet -- he is on holidays. I've produced a video that shows the tendon dislocating. I plan to put it up on youtube in the next 24 hours.

What a mission!

[dibblego]

Thank you everyone for your helpful advice and support. I have finally proven to the world what my problem has been for the last 23 months after 4 operations with some amount of success but still having some sort of problem which nobody could not work out.

You may see it for yourself
YouTube - Peroneal Tendon Subluxation

What a mission. Thanks again. A serious operation awaits me. I know far too much about ankle anatomy and conditions. I am a computer scientist, not a medical expert!

*wipes brow of sweat* What a story for my grandchildren.