Today on the Doc On The Run Podcast, we’re talking about ankle pain versus sinus tarsi impingement when running.
If you get aching pain in your ankles when you’re running and it really seems to lag and doesn’t just go away, you might not have ankle pain at all. There’s a thing that I see often in runners that it seems like ankle pain and the people who call me are complaining of ankle pain, but when I actually look at those runners, it’s a different condition altogether, and that condition is something called sinus tarsi improvement. And so I think it might be helpful to explain that so you can better understand it.
When we look at your foot from the side and we’re looking basically at your ankle joint, and go ahead and make comments about how terrible my drawings are. I know. I’m not an artist, I’m a podiatrist. This is the best I can do. But you’ve got lots of things in your feet that matter. So, you have the heel bone. You have the talus bone sitting on top of the heel bone, and then you have the tibia sitting on top of the talus. Well, this joint, of course, right here, well, that’s your ankle. So your ankle joint is where the talus and the tibia come in contact. Underneath there is a different joint. That joint is the subtalar joint. Sub, meaning under the talus bone. So this is the talus. Subtalar joint is down here. It’s under the talus.
So, one of the things that happens is you can get pain actually in this joint called the subtalar joint. And because you can actually look at a foot model all the way through, and you can see basically a hole all the way through there. Well, we call that the sinus tarsi. And the sinus tarsi is actually part of the subtalar joint. And if we do another picture to show you where that is, if we look at your foot from above, obviously your toes and your heel and all that stuff, you’ve got the metatarsal bones all sitting in here like that. And then you’ve got the cuboid bone, the cuneiform bones, the navicular bone, and the talus sits on top of your heel bone here. And so, the sinus tarsi is basically this sort of canal that goes all the way through here, that way, and it’s under the talus.
How does this happen? Well, if we look at this from one more view from the back, where this is the heel bone and the talus is sitting on top of the heel bone, then you have your tibia and your fibula. What happens is that when you actually rotate too far this way so that the foot’s collapsing, as in the case of pronation, that when you get pronation and your heel tilts over, it actually jams the tissue inside what we call the sinus tarsi. So as you run on the road, for example, let’s say it’s your right foot, and let’s say you’re running with, here’s the slope of the road where you have the lines coming down the road like this, so that’s the middle of the road. Let’s say you’re running over here by the gutter and you’ve got your feet on there. Well, this foot is pronated. This foot is supinated, because the slope of the road is actually tilting your foot. And when you tilt the foot in that direction, it pronates you just like this.
If you’re running in the road facing traffic and it’s your right ankle that you’re complaining about, there’s a good chance that the slope of the road is actually jamming that subtalar joint over and over and over and pinching what we call the synovial tissue, or the lining of that joint. And that pinching of that tissue is what we call impingement. So if you get sinus tarsi impingement because you’re running on the slope of the road, or because you have flat feet and you’re running in shoes that are too unstable for you, well, that could be causing this thing that you think might be ankle pain, but it might actually be this.
The way you can tell is that usually if you look down on your foot right about here, there’s a soft spot that you can push into. It’s below your ankle. Most people say, “It’s where my foot connects to my ankle.” But if you push in that spot and it’s tender, it’s probably synovial impingement or sinus tarsi impingement. That’s actually the subtalar joint under the ankle and not the ankle at all. If that’s the case, then you can do some stuff to address it, one of which might be literally just running on the other side of the road to see whether or not that pain starts to go away. If it does start to go away just because you run on the opposite side of the road with the road sloping you in the opposite direction, you might be onto something.
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