Ankle and foot
Ultrasound-guided injection of the sinus tarsi (subtalar joint)
The subtalar joint, often responsible for lateral and posterior ankle pain, is reached with precision under ultrasound guidance.
How it is performed
The sinus tarsi is the space between the calcaneus and the talus that houses the subtalar joint, responsible for the inversion-eversion movement of the foot. When it develops osteoarthritis, it causes lateral pain and instability. Using ultrasound, the joint is identified and the needle is introduced under direct visualisation, with high accuracy even in patients with swelling or deformity; a corticosteroid or hyaluronic acid is then injected. Outpatient procedure.
Who it is for
- Subtalar osteoarthritis with lateral and posterior ankle pain
- Persistent pain after a sprain (residual instability)
- Sinus tarsi synovitis not responding to conservative treatment
Recovery
You can walk immediately, avoiding load-bearing activity and sport for 48 hours. Relief appears within a few days.
Conditions treated in this area: ankle (tibiotalar) osteoarthritis, sinus tarsi / subtalar joint osteoarthritis, plantar fasciitis and heel pain, achilles tendinopathy and tendon sheath disorders (posterior tibial, peroneal).
Scientific evidence
Accuracy studies show that ultrasound-guided injection of the foot and ankle joints reaches the correct site in over 90% of cases, compared with much lower rates with the freehand technique. Ultrasound guidance of the subtalar joint is recommended given its depth and proximity to tendon and vascular structures.
References on PubMed
- Accuracy of ultrasound guided injections in the foot and ankle.
Reach JS, Easley ME, et al. — Foot Ankle Int, 2009 · PMID 19321101
- Ultrasound-Guided Interventional Procedures in Pain Medicine: A Review of Anatomy, Sonoanatomy, and Procedures: Part VI: Ankle Joint.
Soneji N, Peng PWH — Reg Anesth Pain Med, 2016 · PMID 26655217
Published data describe average results in groups of patients and are not a prediction of an individual outcome. The indication for treatment must always be assessed during a consultation.
Risks, costs and opinions
The three questions patients ask most often before deciding, with clear answers.
What are the risks of ultrasound-guided injection of the sinus tarsi (subtalar joint)?
It is an outpatient procedure performed with a thin needle under local anaesthesia and continuous ultrasound guidance, which makes it possible to see the needle, the target and the structures to avoid in real time. The most common issues are transient: pain or swelling for 24-48 hours, a small bruise. Joint infection is a rare event, prevented by sterile technique. In treatments with cortisone, facial flushing or a temporary rise in blood sugar may occur in diabetic patients. Personal risks and contraindications are assessed during the consultation.
How much does the ultrasound-guided injection of the sinus tarsi (subtalar joint) cost?
The cost depends on the setting in which the procedure is performed: some treatments are available through the National Health Service or under agreement, others privately or through insurance. The quote is given clearly before scheduling the treatment, and includes the assessment, the procedure and the planned follow-up. During the consultation I tell you which pathway is available in your case: you do not have to decide before knowing the cost.
Does it really work? What patients and the literature say
The most frequent questions are "how long does the benefit last?" and "can I repeat it?". The answer depends on the diagnosis and the stage: some injections resolve the painful episode, others serve to open a window in which rehabilitation becomes effective. Experiences read in forums concern cases different from yours. During the consultation we review your imaging and I tell you frankly what to expect, how many sessions may be needed and when another approach is better.
Want to know if it is right for you?
At the first consultation we review your clinical history and previous imaging together.