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The Second Joint in Your Ankle

Subtalar Arthroscopy for Cartilage, Impingement, and Instability

There's a second joint in your "ankle" — and it's where a lot of stubborn outside-of-the-ankle pain actually lives. The subtalar joint sits just below the ankle, between the talus and the heel bone. When it's inflamed, scarred, or unstable, patients describe an ankle sprain that simply never healed.

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By Victor R. Prisk, MD, FAAOS — Board-Certified Orthopaedic Surgeon, Foot & Ankle Fellowship (HSS) · Last updated August 2026

At a Glance

Best for
Sinus tarsi syndrome, subtalar pain
Key test
Image-guided diagnostic injection
Surgery
Outpatient — tiny portals
Outcomes
80–90% good-to-excellent*
Therapy
Within the first weeks
Return to sport
Roughly 2–4 months

The Usual Suspect

Sinus Tarsi Syndrome

The sinus tarsi is a small bony channel between the heel bone and the talus. After ankle sprains — sometimes months after — it can fill with inflamed tissue and scar, causing persistent pain and a sense of instability, especially on uneven surfaces. I wrote a full guide: Sinus Tarsi Syndrome — the ankle sprain that won't heal.

Diagnosis is largely clinical: tenderness directly over the sinus tarsi, pain on uneven ground, and — the most convincing test we have — relief after a small fluoroscopy-guided diagnostic injection of local anesthetic into the canal, done right in our Monroeville office. MRI helps exclude the mimics: peroneal tendon tears and cartilage lesions.

The Proof Test

Numb It, Know It

If a precise anesthetic injection into the sinus tarsi erases your pain, we've found the source. It's diagnosis and short-term treatment in one visit.

Conservative First

The First 3–6 Months

Most sinus tarsi pain settles without surgery:

Peroneal strengthening

Rebuilding the dynamic stabilizers that protect the joint.

Balance retraining

Proprioceptive work with our on-site P.O.W.ER physical therapy team.

Bracing & orthotics

Support and alignment correction when foot shape contributes.

Targeted injections

Fluoroscopy-guided — diagnostic and therapeutic at once.

When the Scope Earns Its Keep

Arthroscopic Sinus Tarsi Debridement

When appropriate conservative care fails, arthroscopic debridement removes the scar tissue and inflamed lining through tiny incisions. In well-selected patients, published results and my experience put good-to-excellent outcomes in the 80–90% range.

When true subtalar instability or cartilage damage coexists, I address it during the same procedure — including ligament repair when needed. And when the ankle ligaments above are also loose, subtalar arthroscopy pairs naturally with a Broström-Gould reconstruction.

Few practices in the region routinely scope this joint. It's small, close to nerves and tendons, and unforgiving of imprecision — which is exactly why fellowship training and volume matter here.

Why P.O.W.

One Roof, Whole Workup

Weight-bearing CT, diagnostic ultrasound, and fluoroscopy-guided injections in one Monroeville office — the workup other practices spread across three facilities happens in one place.

  • Fellowship-trained at the Hospital for Special Surgery
  • Focused on athletes and dancers
  • Independent practice — operating privileges at both AHN and UPMC facilities

Hurt at Work?

We treat workers' compensation cases and provide independent medical examinations.

The Comeback

Recovery

  1. Same-day surgery

    Tiny portals, home within hours.

  2. Early protection

    Boot early; therapy within the first weeks.

  3. Strength & balance

    Progressive loading on the P.O.W.ER protocol, in my building.

  4. Graded return to sport

    Timeline depends on what was done inside; you'll have it in writing.

*Good-to-excellent outcome range reflects published results for arthroscopic sinus tarsi debridement in appropriately selected patients.

Questions Patients Ask

The Subtalar Joint, Answered

What is the subtalar joint?
The joint just below your ankle, between the talus and heel bone. It controls side-to-side foot motion on uneven ground — and it's a common hiding place for pain blamed on "an old sprain."
How do you know the pain is coming from the subtalar joint?
Tenderness directly over the sinus tarsi, pain on uneven surfaces, and — most convincingly — relief after a small image-guided numbing injection into the canal. If numbing the joint erases the pain, we've found the source.
Do I need surgery for sinus tarsi syndrome?
Usually not. Most cases settle with 3–6 months of targeted therapy, bracing, and injections. Surgery is for the minority whose pain persists despite proper care.
How successful is subtalar arthroscopy?
In appropriately selected patients, arthroscopic sinus tarsi debridement delivers good-to-excellent outcomes about 80–90% of the time.
Is this covered by insurance?
We are in-network with Highmark/BCBS, UPMC, Aetna, Cigna, United, most Medicare plans, and others. Call the office to confirm your specific plan.

Prisk Orthopaedics and Wellness

If Your Sprain Never Healed, Look Below the Ankle

Persistent outer-ankle pain deserves a real answer — and often, it's the subtalar joint.

Request an AppointmentCall (412) 525-7692

2490 Mosside Blvd, Monroeville, PA 15146  ·  Serving Pittsburgh, Monroeville, Murrysville, Plum, Penn Hills & Greensburg  ·  Insurance accepted