FOOT INJURIES

Clinical picture Most commonly it is the representation of proprioceptive damage following an acute ankle sprain. The pain often persists and is severe some months after the original trauma. The most painful spot is located beneath and in front of the lateral malleolus. There are no physical signs and the provocation of the intense pain at the mouth of the sinus tarsi remains characteristic of the condition.

Investigations ● Reduction or abolition of the pain by local anaesthetic infil- tration of the sinus tarsi is often diagnostic of the condition ● Arthrograms ● MRI scan

Treatment ● Intensive course of physiotherapy with exercises and physio- therapeutic modalities

Figure 14: Treatment of sinus tarsi syndrome by steroid injection

● Foot orthoses ● Ankle braces in very painful cases ● Steroid injection under CT guidance (Fig.14) for accurate place- ment of the needle in the ST canal ● Surgery

Nat Padhiar is an honorary consulltant and research podaitrist within the surgical and musculoskeletal directorate at the Royal London Hospital. He is also a member of the medical team supporting the Daily Telegraph marathon squad.

With thanks to Martin Dunitz Publishers for their kind permission to reproduce figure 2. From Sports Injuries: Their Prevention and Treatment (3rd Edn). ISBN

1-85317-119-0. The book costs £40 Figure 13: MRI of stress fracture to the calcaneus and is available by telephoning 020 7482 2202.

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