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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.
Causes of Sinus Tarsi Syndrome?
- Flat Foot Deformity leading to poor pronation control can lead to an overload of the lateral ankle.
- Repetitive ankle sprains can cause trauma to the sinus tarsi.
- A single significant ligament sprain can overload the Sinus Tarsi
- Hypermobility can lead to poor foot control and subtalar instability that irritates the Sinus Tarsi.
- It is common in runners due to the high forces involved in running, especially on a camber, and certain types of running shoes can lead to an overload of the outer ankle.
- Subtalar joint arteritis can cause irritation and pain within the Sinus Tarsi.
- We often see Sinus Tarsi Syndrome in hurdlers due to repetitive impact.
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 in the area 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.
Diagnosis of Sinus Tarsi Syndrome
If you have the symptoms of Sinus Tarsi Syndrome we recommend that you see a Physical Therapist, Podiatrist, or Sports Doctor for a clinical assessment, following this they may refer you for imaging to confirm your diagnosis but this is not always necessary.
Clinical Test
Clinical tests for Sinus Tarsi Syndrome include dorsiflexing and everting the foot while palpating the sinus tarsi. If this provokes the symptoms, it is a positive test for Sinus Tarsi Syndrome.
MRI
An MRI is the most accurate form of imaging for Sinus Tarsi Syndrome. It can identify potential causes such as inflammation, osteophytes or degeneration of the joint.
Ultrasound
This is another highly accurate form of diagnostics for Sinus Tarsi Syndrome and it is very cost effective.
Sinus Tarsi Syndrome: Home Treatment
- Reduced the amount of time on your feet
- Apply ice to the area for pain relief
- Taking anti-inflammatory medicine
- Wear supportive cushioned shoes
- Avoid high impact activities
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.
Sinus Tarsi Syndrome Exercises
Posterior Tibial Tendon Band Exercise
- In a seated position place your ankle over your knee
- Place a band around you both feet
- Point your toes and then lift your ankle upwards
- Slowly return to your starting position
Soleus Stretch
Your soleus muscle is part of your calf muscle group and plays a very important role in walking and running. The tighter your soleus is, the quicker you transition onto your big toe.
- Standing upright, facing a wall.
- Bend your knee while keeping your heel on the floor
- Bring your knee as close to the wall as possible
- Hold in this position for 45 seconds
Standing Calf Stretch
Your Gastrocneumius is the second major muscle in your calf muscle group. It can be helpful to stretch this as well.
- Standing upright, facing a wall.
- Place one leg straight behind you and your other leg in front
- Keep the heel of your hindfoot on the floor and lean forward against the wall
- Once you feel a pull on the back of your left stay in this position
- Hold in this position for 45 seconds
Peroneal Band Strengthening
The peroneal muscles are on the outer side of your ankle. It helps to turn your foot outwards and is a key stabiliser of the ankle.
- In a seated position, place the band around both feet
- Keep one foot static
- Turn the other foot out against the resistance of the band
- Slowly return to your starting position to complete a repetition
Soleus Raises
- Stand on the edge of a step, with your knees bent
- You can hold onto something stable for your balance
- Let your heels drop down over the edge of the step, keeping your knees in the same position
- Lift both heels up, as high as possible
- Slowly lower your heels down to your starting position
Online Physiotherapy with James McCormack
This is not medical advice, and we recommend a consultation with a medical professional such as James McCormack to achieve a diagnosis. He offers Online Physiotherapy Appointments weekly.
Related Article: Sinus Tarsi Syndrome: FAQs