Sinus Tarsi Syndrome

Sinus tarsi syndrome is something of a paradox. It can be caused by an excessively inverted foot and sinus tarsi syndrome can also be caused by an excessively everted foot.

Sinus tarsi syndrome caused by an excessively inverted foot is the ankle sprain. During an ankle sprain the structures in the sinus tarsi can get stretched. They often get missed as the initial diagnosis of an ankle sprain due to the pain and swelling. It is only later that sinus tarsi syndrome gets diagnosed as a chronic problem following the ankle sprain. The pain is usually felt on the outside of the ankle joint. Sinus tarsi syndrome following ankle trauma usually responds really well to physical therapy and home exercise programs. Sometime a steroid injection into the sinus tarsi is helpful.

The other cause of sinus tarsi syndrome is an excessively pronated foot. This foot forces the subtalar joint to the end range of pronation or eversion and compresses the lateral side of the sinus tarsi. This produces pain on the outside of the ankle joint. This type of sinus tarsi syndrome responds really well to foot orthoses designed to keep the subtalar joint from pronating to its end range of motion.

Tarsal Coalition

Just got back from taking the girls to their ballet class (usually the wife does that) and ended up making the usual small talk with the other mums (not dads their unfortunately). Needless to say sometime I admit what I do for a job and the topic got to feet. This time it was actually interesting. What the mother related to me was clearly a case of tarsal coalition without me even looking at their kid (they were busy dancing). I obviously did not say much, but the really need to get to see someone who knows what they are doing. They had been mucked around by many different health professionals.

A tarsal coalition is a fusion of bone between two bones in the rearfoot (tarsus). The most common ones are a talocalcaneal coalition and a calcaneonavicular coalition. I usually like to send them for surgical consult as this is going to be there forever and if it can be removed, why not remove it? If that is not an option then some sort of foot orthoses can be used to limit motion which usually helps the symptoms.

I had to make a number of subtle suggestion as to what might be going on in this child foot and what they might need to do to get the right advice. Obviously without the benefit of an x-ray and a full examination, I was only speculating. I made this really clear to her.

Cracked Heels

One somewhat disadvantage of having a profile online is that I make comments on a lot of issues at places like Podiatry Arena (see my profile) and I get emails and phone calls about conditions that I may not necessarily know a lot about, but I just happened to make a comment on it. Unfortunately I have to ignore most as I just do not have the time and am not resourced to deal with them. Often though I will just refer them to the Foot Health Forum and they should be able to get help there.

The most recent email I got was about cracked heels! (not even close to my area of expertise!). Not sure what they were expecting. ePodiatry has a good resource and explanation on Cracked Heels. There is info on the Foot Health Forum on Cracked Heels and if you need help, take your cracked heels to my wife’s clinic. There are some other resources here, here, here and here on this.

Severs Disease

At the moment working on resources for the students for Severs Disease;

Drawing a lot from Podiatry Arena
Plantar Pressures in Severs Disease
Severs disease
Risk factors for Sever’s disease
Pronation control for in toeing adolescent with Severs disease
Ketoprofen and Severs Disease
Is Severs Disease a stress fracture?
Taping and Sever’s Disease
Sever’s disease and unilateral heel raise
Severs disease treatment
Sever’s disease—Does it effect quality of life?
Sever’s disease in a 4y/o???
Osgood Schlatters/Sever’s Disease
Should we x-ray for Sever’s Disease?
Insoles effective for Severs Disease
Severs Disease Treatment with a Heel Cup
Calcaneal Apohysitis or Stress fracture

and questions at the Foot Health Forum:
Sever’s Disease in young child
9 year old with sever’s disease
Severs disease?
No response to treatment for Sever’s disease
Sever’s Disease – Surgery

ePodiatry has a good lay description on Severs Disease.
Heel cups for severs disease are a common treatment.

Passing of a friend

I was enjoying my holiday in Bright with the family on the last day of 2010, when a text turned up on my phone. A colleague and friend had passed away. I had to ring Peter to find out more. It was a real downer and had a big impact on me. I started a thread on Podiatry Arena on Graham Curryer and went for a beer in his honour. He and I have shared many a beer, as recently as September in Toronto. What a way to end the year. The tributes posted on Podiatry Arena by others says a lot.