Don't Let Your Patients Suffer From Talar Misalignment & Instability Aligned Talus Misaligned Talus Talar Misalignment & Instability Leads to Increased Causes Talar declination angle Obliteration of the sinus tarsi Talar 2nd metatarsal angle Anteriomedial shift of weightbearing forces Cyma line Navicular drop/sag Forces acting on the talonavicular joint Alters alignment of the knees, hips and back Mechanical strain to the plantar fascia Growing pains/shin splints Strain to the posterior tibial tendon Functional leg length discrepancy, and/or pelvic tilt Forces acting under the 1st MPJ Strain to the posterior tibial nerve Pressure within the tarsal tunnel & porta pedis Common Treatment Options for Talar Misalignment & Instability Include Orthotics Osseous Reconstruction You can clearly see that the sinus tarsi remains closed even though this patient is wearing their orthotic. This is because orthotics don't solve the problem. They only help to ease the symptoms. This is an aggressive form of treatment that requires a long recovery, is associated with numerous risks and complications, and often irreversible. Additionally, many patients return to the operating room for removal of internal hardware such as pins, screws or plates.