#876 Should I have serial injections for sinus tarsi syndrome - DOC

#876 Should I have serial injections for sinus tarsi syndrome

Should I have serial injections for sinus tarsi syndrome? Well, that is a great question and that is what we are talking about today on the Doc On The Run Podcast.



I saw a runner today and I did an injection for sinus tarsi syndrome, and she asked me a great question. She said, “Is this something I am going to need to do every three to six months or something?”

She had been reading up on this and she had seen where for certain conditions, it’s normal to go in and do a treatment every few months or a certain number of times a year. And so, what we are talking about here is serial injections meaning of course, serial, not cereal, right? So no, no, there’s no breakfast cereal that has been shown to improve sinus tarsi syndrome, as far as I know. But if you have any research on that, post in the comments.

Serial injections, what does that mean? We are going to do an injection over and over. Why would you that for sinus tarsi syndrome? Well, because you have inflammation in the sinus tarsi or the subtalar joint. So, what is the sinus tarsi? Well, if you look at the heel bone sitting here, and then the talus bone sitting on top of the heel bone, and then you have a bunch of other bones in here that you really don’t care about all that much. So, we are not going to draw all of them, but this is basically your foot. That spot right there, that hole that you can sort of see through when you are looking at a foot model that goes straight through the foot, that is the sinus tarsi.

When we look at it from a different angle, like up above. Go ahead and make comments about how childish my drawings are. I know they are not good. But that is the best I can do. So here is the thing, you have basically your talus. This bone, this is the talus. So, the talus is sitting on top of the heel bone and then like I said, you got all these other bones that you don not really care about. So, all those are in here, and so on like that.

The Sinus tarsi is a canal. It’s a space between goes in here, underneath there and comes out here. That is the sinus tarsi. So, the sinus tarsi goes underneath the talus and comes out the other side. So, you get inflammation in there and the reason that happens is a couple of things. The most common ways you sprained your ankle, you roll your ankle, you twist it, you stretch that tissue, the lining of the joint called the synovial tissue that makes the synovial fluid that lubricates the inside of the joint and keeps the cartilage healthy, well, that  gets inflamed, it can’t swell outward, so it swells inward. And then you pinch it between those two bones when you are pronating and supinating, your foots moving around. So, you run on an angulated surface, you step on a driveway cut out, you jam it all of a sudden, then the next thing you know, it swells a little bit and you have sinus tarsi syndrome. It’s inflammation in the subtalar joint.

How would an injection fix this? What we are talking about is a cortisone injection, corticosteroids. The best thing to stop inflammation and it reduces the swelling, that tissue shrinks back and recedes. So, it doesn’t get pinched in there anymore. So, would you do this repeatedly? Well, not necessarily. In fact, most of the time “No” is the answer because I want somebody to get back to running.

Let’s say you have a ton of swelling. It’s been aching for two years and then you finally see a doctor and the doctor says, “You have sinus tarsi syndrome. We are going to squirt a little steroid in there. It will be good as new.” And it improves a lot, but it doesn’t really recede completely. It feels so much better within a couple of weeks that you start running again, but the tissue still kind of swollen so you still kind of pinch it and tweak it a little bit and it sort of swells up again.

Then maybe several months later, it gets worse, or you have been running, everything has been fine and a year later, you are running on the beach, your foot is sliding around a lot, and it jams the subtalar joint and that tissue swells up again. And then you are thinking okay, is this something I just have to do every few months? Not in that scenario.

The only reason you would do a serial injection is you have a problem that we do not really think is not going to get better per se by doing it on a schedule of like every three to six months after the injection wears off. We would just do it again to stop the inflammation unless you have a joint that is basically destroyed, and we are just trying to buy you some time because for whatever reason you cannot have like a fusion or a definitive surgery that is going to  stop the pain by removing the joint and fusing the joint instead.

In that case, yeah, a doctor might do that if for example, you had a lot of pain and you wanted to have surgery to fuse the joint, but you did not want to do it until next year. Well in theory, you could do several injections to stop the pain in the interim. but you don’t want to do it right before the surgery because it can decrease your chance of  healing after the surgery.

When we are talking about this scenario, we are doing cortisone to really get the synovial tissue to calm down, to stop bothering you so you can run. We hope that it will only be once, maybe twice to really shrink that tissue down and stop the inflammation and allow you to get back to running. Not a thing you should have to do over and over and over. You don’t want to do that because there’s risk associated with that too.

Hopefully this helps you understand a little bit more about sinus tarsi syndrome and when a corticosteroid injection or a cortisone injection might  be helpful. If you liked the episode, please like it, please subscribe and I’ll see you in the next training.