Sinus Tarsi Syndrome

Sinus Tarsi Syndrome Anatomy

The sinus tarsi is a small articulation on the outside of the ankle bone between two bones, the talus and calcaneus bone, that make up a joint in the ankle called the subtalar joint. The articular spacing between these two bones facilitates a small tunnel for passing through blood vessels, nerve endings, ligaments, and tendons. 

An anastomosis of the sinus tarsi and tarsal canal arteries provides the vascular supply of the sinus tarsi. The extensor digitorum brevis muscle attaches to the inner and upper aspect of the sinus tarsi, crossing over the calcaneocuboid joint. The inferior extensor retinaculum lies over the lateral aspect of this space and serves as a covering over the sinus tarsi.

The structure of the sinus tarsi provides stability to the surrounding ankle joint. When overloaded through repetitive motion or trauma, this area can lead to pain and inflammation, resulting in Sinus Tarsi Syndrome.

Due to the location of the sinus tarsi, injury to the area known as Sinus Tarsi Syndrome is often confused with a lateral ligament sprain.

Sinus Tarsi Syndrome: Symptoms

Sinus Tarsi Syndrome pain is located on the outside of the ankle joint. It is usually tender when palpating the Sinus Tarsi, and symptoms are aggravated by turning the foot outwards.

Low-grade swelling is often seen in the outer ankle and may be associated with some tingling or burning as the swelling compresses local nerves.

Symptoms are often exacerbated by walking on uneven surfaces, wearing unstable footwear, or running uphill. Standing for extended periods can worsen the pain or compress the area from tight shoes.

We expect the pain to ease with rest, but it can be uncomfortable if direct pressure is applied to the area.

Treatment For Sinus Tarsi Syndrome

Physical Therapy is the most effective form of treatment for Sinus Tarsi Syndrome. A Physical Therapist may use rigid taping or an ankle brace to help control movement at the subtalar joint to provide pain relief while KT Tape has minimal effectiveness as a form of treatment for this condition. Massage and ankle joint mobilisations may be used to reduce pain levels.

Strengthening and balance exercises alongside ankle stretches are extremely effective in addressing the biomechanical causes of Sinus Tarsi Syndrome. They can be used in addition to custom insoles or orthotics which space the sinus tarsi.

In very irritable cases, an ultrasound-guided corticosteroid injection may be carried out by a Radiographer or Sports Medicine Doctor to reduce inflammation in the Sinus Tarsi. This should be followed by a comprehensive rehabilitation protocol.

Surgery for Sinus Tarsi Syndrome is rarely required but in cases where conservative management fails, an osteotomy or arthroscopy may be recommended.

Can I run with Sinus Tarsi Syndrome?

In our experience, running with Sinus Tarsi Syndrome is not recommended, especially in the acute phase of the condition when symptoms are most severe. Here’s why:

1. Risk of exacerbating symptoms: Running is a high-impact activity that places significant stress on the ankle joint. The high stress and impact can overload the sinus tarsi and increase inflammation and pain.
2. Instability: Sinus Tarsi Syndrome is often caused by ankle instability. Running required high levels of ankle stability; therefore, if an individual has poor ankle stability, it can overload the sinus tarsi and worsen symptoms.

However, maintaining cardiovascular fitness is important, and there are many other low-impact exercises that you can do while you recover:

1. Swimming and Water Aerobics: These provide a full-body workout without placing excessive stress on the feet and ankles.
2. Cycling: This can also give a good cardiovascular workout with less impact on the lower limbs. We have spoken about this in greater detail below.
3. Strength Training: Focusing on upper body and core exercises can help maintain overall fitness and stability. Using machine weights can reduce your risk of ankle irritation.
4. Pilates and Yoga: Both of these are excellent options for increasing flexibility and strength, reducing the risk of future injuries.

A physical therapist can conduct a running gait analysis to assess for any signs of overloading the outer ankle and suggest modifications to your running form if necessary.  Advice on running shoes is an important part of the recovery process.

Physiotherapy with James McCormack

This article is written by James McCormack, a Lower Limb Specialist who is an expert in treating Sinus Tarsi Syndrome.

This is not medical advice. We recommend a consultation with a medical professional such as James McCormack if you are experiencing any of the symptoms discussed in this article. James offers Online Physiotherapy Appointments weekly and face-to-face appointments in his London clinic.