Dr. Kevin Yip

Dr Kevin Yip
Orthopaedic Surgeon
MBBS(UK), FRCS(EDIN), FAM(SING), FHKCOS(ORTHO)

Featured on Channel NewsAsia

Sub-Talar Instability and Pain

SYMPTOMS

There is increasing stiffness or sense of instability combined with diffuse aching pain around and below the talo-tibial ankle joint, often occurring after previous sprain.

AETIOLOGY

The aetiology is unclear but the trauma may have caused structural damage to the region that can be missed.

CLINICAL FINDINGS

There is tenderness on palpation over the sub-talar joint (sinus tarsi) during forced inversion. Occasionally there is a combined sub-talar and tibio-talar laxity that makes the diagnosis difficult.

INVESTIGATIONS

X-ray is often normal. MRI may show oedema and swelling in the sub-talar joint.

TREATMENT

Initially try orthotics to support the foot arch. NSAID or local cortisone injections can give short-term relief. Surgery is seldom indicated.

REFERRALS

Refer to podiatrist or physiotherapist for mild symptoms and to orthopaedic surgeon if there are severe or progressing symptoms.

EXERCISE PRESCRIPTION

Rest will not help so allow all kinds of sporting activities, using well-fitting shoes and avoiding impact. If there is pain on impact suggest non-impact activities such as cycling and swimming as alternatives.

EVALUATION OF TREATMENT OUTCOMES

Monitor the decrease of clinical symptoms and signs.

DIFFERENTIAL DIAGNOSES

Tarsal coalition; tumour (X-ray and MRI will differentiate); stress fracture (X-ray and MRI will differentiate);
osteomyelitis (signs of infection, fever, positive blood tests for CRP, ESR); OCD (X-ray and MRI will differentiate); osteid osteoma (X-ray and MRI will differentiate).

PROGNOSIS

Good-Fair. The symptoms can be prolonged with or without surgery.

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