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Post tib/sinus tarsi probs, some advice please

Discussion in 'Biomechanics, Sports and Foot orthoses' started by mishkabelle, Aug 29, 2011.

  1. mishkabelle

    mishkabelle Member


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    Hi all,

    I was hoping for some advice on a interesting case

    Male patient, 64 years old. Healthy, only taking Lipitor

    PRESENTING COMPLAINT
    Many months of on again off again pain in the left foot
    1: Lateral aspect of Inf Extensor retinaculum. This is mild
    2: When rearfoot is fixed and midfoot/forefoot everted. This is severe and at its worst when walking on uneven ground

    BIO
    Pes planus
    STJ / MTJs restricted
    Tib Post weak compared to right side, other muscles showed good strength
    Equinus (gastro and soleal)
    Supinatus
    RSCP 10 deg NCSP 0 (right side is 8 and 0)
    Medially deviated STJ
    Very very high SRT
    Functioning at the end ROM (minimal pronation possible when standing in RSCP)
    Abducted gait

    The severe pain the patient reported was concerning me so I asked him to get an MRI. The results indicated advanced tib post dysfunction with secondary sinus tarsi syndrome. It also mentioned that there was degeneration of the deltoid, spring and bifurcate ligaments.

    I am interested to know if this man would benefit from an injection into the sinus tarsi, and if I should be seeking a surgical opinion. He has been wearing what looks like a pair of modroots since 2004 that are not giving him the control he needs so I was planning on an inverted device made from rigid polyprop, a medial skive of 8mm, high heel cup and a rearfoot post. Am I missing anything?

    Thanks
    Eliza
     
  2. Eliza:

    Here is a paper I wrote eleven years ago which should help. Good luck.
     

    Attached Files:

  3. nick_700

    nick_700 Active Member

    Kevin, thanks for the article very interesting

    Eliza

    My standard approach is similar to what Kevin describes, early immobilisation is essential to allow the posterior tibial tendon to settle. Don't be bewildered by the MRI - these cases typically show up like a Christmas tree on T2 films. Kevin's article summarises the pathological forces that occur to the supportive ligamentous structures very well.

    The only other thing I routinely do is put the patient in an ASO brace (or similar) immediately, incorporating an inversion/supination bias when applying the brace. In the future depending on the patient I may consider immobilisation as Kevin has suggested depending on the severity of the case.

    With regards to sinus tarsi injection, a small number of my patients have had this performed by local sports physicians who they have been concurrently seeing with good success, however I would be interested to hear others' experience with it.

    Good luck.
     
  4. kirstyq

    kirstyq Member

    Trezatment: Ritchie Brace, stretching , mobilisation, massage.
     
  5. mishkabelle

    mishkabelle Member

    Thanks everyone.

    Kevin, thanks for passing on your article, it neatly summarises everything I need to know.
    One more question. The severe pain my patient experiences when the rearfoot is fixed and the midfoot and forefoot are everted, is that likely to be due to the closing off of the sinus tarsi and therefore compressing already damaged structures?

    Enjoy this magnificant day Melbournians

    Eliza
     
  6. carolethecatlover

    carolethecatlover Active Member

    Honourable Dr Kirby, Love your work,
    When is your new book being published?
     
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