Sinus Tarsi Syndrome

Sinus Tarsi Syndrome is painful condition that is described and discussed in the blog below. Hopefully you can get some helpful advice from the following and for further information then please contact us.

What is Sinus Tarsi?

Sinus Tarsi is a small cylindrical cavity located in the ankle, which extends out into the heel bone, as seen in the picture below. The Sinus Tarsi has numerous anatomical structures running through it including: blood vessels, ligaments, connective tissue and nerves, which contribute to the balance and proprioception of the foot.


Causes of Sinus Tarsi Syndrome

Sinus Tarsi syndrome results from instability in the subtalar joint. The two most common causes of this are ankle sprains and the pronated foot (flat foot). The condition can cause persistent pain, inflammation and tenderness to the structures.

Ankle sprains can initiate instability within the subtalar joint either after a single sprain or continual sprains. The instability can result in excessive movement within the joint, which can in-turn cause inflammation and formation of scar tissue within the sinus tarsi canal.

Symptoms of Sinus Tarsi Syndrome

Symptoms of sinus tarsi syndrome tend to come on gradually over time. Symptoms of ankle sprain injuries never fully settle even if the injured ligament fully heels, due to the resultant irritation of the sinus tarsi region.

The most common sinus tarsi symptoms are:

  • Pain (burning/deep ache possibly shooting/numbness) tends to radiate from the area around the outside of the foot/ankle
  • Pain will worsen with prolonged activities such as walking or running, however it will subside with rest.
  • Instability: patients will feel like their ankle could give and sprain at any time.
  • Stiffness at the ankle may be present in the morning

Diagnosing Sinus Tarsi Syndrome

An MRI scan is the best way to see what is going on in the sinus tarsi structures.  It will show any inflammation and scarring in the area. Initially however another common diagnostic tool is to inject the sinus tarsi region with local anaesthetic and possibly combining this with corticosteroids.  Cessation of symptoms indicates a positive diagnosis of sinus tarsi syndrome.

The effects of the injection are usually short lived especially if only local anaesthetic is administered.  If symptoms fail to settle after an injection, the problem is unlikely to be sinus tarsitis.

Treatment & Prognosis

When diagnosed early, a full recovery can be made in just a few weeks.  However, if the problem is not addressed in the early stages, or if a rehab programme is not adhered to, sinus tarsi pain can become a chronic problem taking months to settle down.  Treatment usually consists of the following:

  • Rest: Any activities that trigger the sinus tarsi pain needs to be avoided to allow time for the tissues to heal.  This may require the use of crutches and or an ankle brace in the short term.
  • NSAIDs: use of non-steroidal anti-inflammatories will help reduce pain and inflammation at the sinus tarsi region.
  • Ice: Regular use of ice will help reduce pain and inflammation.
  • Physical therapy: Regular sessions can help address some of the causes of sinus tarsi pain. Treatment may include; joint mobilisations to address any areas of stiffness around the ankle, low level laser therapy (to reduced inflammation) and taping to limit movement of the subtalar joint and reduce the amount of pronation by supporting the arch of the foot.
  • Footwear and orthotics: Supportive footwear can restrict excessive pronation and reduce the likelihood of ankle sprain preventing further injury. Patients suffering from abnormal foot biomechanics such as pronated foot can be prescribed orthotics to correct the condition.

Please do not hesitate to contact The Footcare Centre 01932 849373 or book online for a consultation with one our podiatrists if you are suffering from what think could be this condition.

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