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Sinus Tarsi Injection

From WikiSM

Other Names

  • Sinus Tarsi Injection
  • Tarsal Sinus Injection
  • Sinus Tarsi Aspiration

Background

Tarsal sinus (eye of the foot) A. Schematic presentation of the bones forming the subtalar joint and sinus tarsi, Nav – os naviculare.; B. X-ray imaging (lateral view) of the tarsal sinus. C. MRI of the subtalar joint, sinus tarsi and ligaments – ITCL – Interosseal talocalcaneal ligament, CL – Cervical ligament, M – Medial root of the inferior extensor retinaculum (IER)[1]

Key Points

  • Needle: 25 gauge, 1.5 inch
  • Transducer: high frequency, linear

Anatomy of the Sinus Tarsi

  • Cone shaped cavity in the posterior/lateral hindfoot
  • Found betwee the neck of the talus, anterior superior aspect of calcaneus
  • Contains fat, neurovascular structures and series of stabilizing ligaments

Palpation Guidance vs Ultrasound Guidance

  • We recommend ultrasound guided aspiration/injection when possible
  • To date, there are no studies comparing ultrasound and palpation guided approaches

Indications

Contraindications

  • Absolute
    • Anaphylaxis to injectates
    • Overlying cellulitis, skin lesion or systemic infection
  • Relative
    • Can be treated with less invasive means
    • Hyperglycemia or poorly controlled diabetes
    • Lack of symptom improvement with previous injection

Procedure

Ultrasound appearance of the sinus tarsi with the transducer positioned in a sagittal oblique orientation with the talus to the left and the calcaneus to the right in the image[2]
Out-of-plane needle approach from anterior to posteromedial with the transducer positioned in a sagittal oblique position[2]
Ultrasound appearance of the step-down needle insertion technique[2]

Equipment

  • Sterile prep (i.e. chloraprep, chlorhexidine, iodine, etc)
  • Gloves
  • Needle: typically 21-25 gauge, 1.5 inch
  • Syringe: 5-10 mL
  • Gauze
  • Ethyl Chloride
  • Bandage
  • Injectate
    • Local anesthetic
    • Corticosteroid
  • Sterile probe cover

Ultrasound Findings

  • Place the probe obliquely so you can see the calcanus and talar neck
  • Then translate proximally, rotate and tilt slightly to find the sinus tarsi
  • Appears as a soft tissue space expanding deep on the screen

Ultrasound Guided Technique: Long Axis, Out of Plane

  • Patient Position
    • Supine
    • Ankle slightly inverted and plantar flexed
  • Transducer Position
    • Obliquely so you can see the calcanus and talar neck
  • Needle Approach/ Orientation
    • Out of plane
    • Posteromedial using a walk-down technique
  • Target
    • Sinus tarsi
  • Pearls and Pitfalls
    • Can't follow needle all the way down
    • Tactile component to evaluate for depth when the needle hits a bony structure

Aftercare

  • Motor exam should be intact
  • No major restrictions in most cases
  • Can augment with ice, NSAIDS
  • Consider Ankle Compression Sleeve

Complications

  • Infection
  • Damage to surrounding tissue

See Also

References

  1. ↑ Katsarov, Atanas. "Sinus Tarsi–The Eye of the Foot and its Anatomical Contradictions." Acta Morphologica et Anthropologica 30: 3-4.
  2. ↑ 2.0 2.1 2.2 Malanga, Gerard A., and Kenneth R. Mautner. "Atlas of ultrasound-guided musculoskeletal injections." (No Title) (2014).
Created by:
John Kiel on 23 June 2025 13:16:26
Authors:
Last edited:
23 June 2025 15:49:52
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