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Canalis Tarsi – Anatomy and Syndrome

The canalis tarsi is an anatomical canal in the ankle region that houses important nerves, blood vessels, and ligaments. Disorders of this canal can cause pain and numbness in the foot.

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Things worth knowing about "Canalis tarsi"

The canalis tarsi is an anatomical canal in the ankle region that houses important nerves, blood vessels, and ligaments. Disorders of this canal can cause pain and numbness in the foot.

What is the Canalis tarsi?

The canalis tarsi (also known as the tarsal canal or sinus tarsi) is a funnel-shaped anatomical space located between the heel bone (calcaneus) and the ankle bone (talus) on the outer side of the hindfoot. This canal connects the anterior and posterior subtalar joints and plays a central role in the stability and mobility of the ankle and foot.

Several important anatomical structures pass through the canalis tarsi, including ligaments, blood vessels, nerve fibers, and tendons. These structures are essential for the biomechanical function of the ankle joint.

Anatomy and Contents of the Canalis tarsi

The canal runs from lateral (outer) to medial (inner) and contains the following key structures:

Ligamentum talocalcaneare interosseum: The strong interosseous ligament connecting the calcaneus and talus, providing primary stability to the canal.
Cervical ligament (Ligamentum cervicis): Another important stabilizing ligament of the hindfoot.
Artery of the sinus tarsi: A small artery supplying the surrounding structures with blood.
Nerve fibers: Branches of the peroneal nerve and tibial nerve that transmit sensory and motor information from the foot.
Fatty tissue: Loose connective tissue that cushions and protects the internal structures.

Sinus Tarsi Syndrome

Sinus tarsi syndrome (canalis tarsi syndrome) is a common condition characterized by inflammation, scarring, or damage to the structures within the tarsal canal. It is one of the most frequent causes of chronic lateral foot pain.

Causes

Ankle sprain (inversion injury): The most common cause, in which the ligaments within the canal are overstretched or torn.
Chronic ankle instability: Repeated injuries lead to scarring and persistent inflammation within the canal.
Inflammatory conditions: Rheumatoid arthritis or other systemic diseases can affect the canal structures.
Foot deformities: Flatfoot or other structural abnormalities can increase pressure on the tarsal canal.
Ganglia or cysts: Benign soft tissue masses can narrow the canal and compress its contents.

Symptoms

Pain on the outer side of the ankle, worsened by weight-bearing or walking on uneven surfaces
Feeling of instability in the ankle joint
Numbness or tingling in the foot and toes (if nerves are involved)
Point tenderness directly over the sinus tarsi (outer ankle area)
Swelling around the lateral ankle

Diagnosis

Diagnosis of sinus tarsi syndrome involves a combination of clinical examination and imaging studies:

Clinical examination: Tenderness test over the sinus tarsi and functional assessment of ankle movement.
Magnetic Resonance Imaging (MRI): The gold standard for visualizing ligament injuries, inflammation, ganglia, or scar tissue within the canal.
Ultrasound: Useful for evaluating soft tissue changes and fluid accumulation.
X-ray: To rule out bony injuries or foot deformities.
Diagnostic injection: A targeted injection of local anesthetic into the sinus tarsi can confirm the diagnosis if symptoms improve significantly after the injection.

Treatment

Conservative Treatment

In most cases, conservative management is the first approach:

Physiotherapy: Strengthening of foot and ankle muscles and proprioceptive training to improve joint stability.
Orthotic insoles: Custom foot orthotics to correct deformities and reduce pressure on the tarsal canal.
Corticosteroid injection: Anti-inflammatory medication injected directly into the sinus tarsi to reduce pain and swelling.
Anti-inflammatory medication: Nonsteroidal anti-inflammatory drugs (NSAIDs) to relieve pain and inflammation.
Immobilization: Temporary rest with a brace or splint to allow healing.

Surgical Treatment

If conservative measures fail to provide adequate relief, surgical intervention may be required:

Arthroscopy: Minimally invasive examination and treatment of the tarsal canal using a small camera.
Open surgery: Removal of scar tissue or ganglia, or reconstruction of damaged ligaments.

References

Zwipp, H. & Rammelt, S. - Tarsus: Surgery of the Foot. Springer Verlag, 2nd edition (2014).
Kier R. - MR imaging of foot and ankle. Magnetic Resonance Imaging Clinics of North America, 2(1):43-68 (1994). PubMed.
World Health Organization (WHO) - International Classification of Diseases (ICD-11), Musculoskeletal Disorders. https://icd.who.int

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