Anatomy
Osseous canal between talus and calcaneum
- interosseous talo-calcaneal ligament
- cervical ligament
- joint capsule
- nerve endings / arterial anastomoses
Aetiology
Flat foot / overpronation
Inversion / sprain
Pathology
Hypothesis
- compression / pinching injury
- develop scarring of ligament and capsule
- predisposes to further pinching
Symptoms
Pain at lateral aspect ankle
- below lateral malleolus
May get pain when running on outside of foot / track work
Pain on uneven ground
Examination
Tenderness sinus tarsi
- soft indentation below and anterior to LM
Pain with eversion / inversion STJ
HCLA
Diagnostic
- relieves pain
MRI
Display fluid in sinus tarsi
May detect excess scar tissue
Management
Non operative Management
Usually very effective
Options
Rest
NSAIDS
Subtalar joint manipulation
Correction of over pronation / orthotics
HCLA
Orthotics to stabilise STJ
Operative
Lee et al Arthroscopy 2008
- 33 cases of subtalar arthroscopic debridement
- 88% good or excellent
- 12% fair
Findings
- partial tear interosseous ligament 88%
- synovitis in 55%
- partial tear cervical ligament 33%
- arthrofibrosis 24%
- soft tissue impingement 21%