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I'm gonna spend just the last few minutes very quickly

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talking about the sub daer joint injuries

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and the ligaments of the tarsal sinus and canal.

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There are a lot of ligaments here, often layers

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of ligaments, superficial, intermediate, and deep.

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Let's just look at that in a little detail.

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Here's my drawing of a coronal section of the Alis

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and calcaneus.

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Here are some of the ligamentous

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and RET macular structures we deal with.

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Let's add the three roots of the

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inferior extensor reticulum, the lateral root in blue,

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the intermediate root in red,

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and the medial root shown in yellow.

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To that, I'm adding the interosseous ligament

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and historic green color and the cerv ligament in orange.

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Let's go ahead and use sagittal sections.

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Here we're seeing some of the roots of the uh,

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inferior extensor ret inoculum shown here.

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As we move a little bit more medially,

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we can see the cervical ligament

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and as we move further medially, we can see

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the interosseous ligament.

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This is just showing you the two joints separated

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by the interosseous ligament and the cervical ligament.

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There is a bursa nearby, it's called the gruber bursa.

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We may see fluid in it.

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Some of these patients have clinical findings consistent

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with bursitis.

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This occurs just lateral to the tail and the vicular space.

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We may deal with a subtalar sprain, typically associated

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with lateral ankle sprains as well,

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and generally an inversion injury

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with a positive subtalar vera stress.

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Typically what we see is a lot of edema

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and sometimes disruption of those ligaments

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in the tarsal sinus and canal.

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And then finally, the sinus tarsi syndrome leading

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to chronic pain

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and weakness, a feeling of instability of the ankle.

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Generally, there is a history of a prior inversion injury

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to the ankle, and in some of those cases,

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as shown in these images, a history of a prior calcan

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fracture with extensive abnormalities in the tarsal

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sinus and canal.

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So what do we look for pathologically

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and with imaging, there are five major findings.

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You can see them listed here,

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the data taken from this article a number of years ago.

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We can look for arthrofibrosis

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as in this particular example.

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We can look for a tear of the cervical ligament

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as in particular example.

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We can look for a tear of the interosseous ligament.

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A very common finding, although in my experience not

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As common as cited in this article, we look can look

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for a variety of findings, synovitis, arthrofibrosis,

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soft tissue impingement.

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And as a quick way to look at this, we look for

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edema within the tars sinus

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and canal, obliterating the fat

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surrounding the cervical and interosseous ligaments.

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We look for the edema, which may highlight ligament failure.