Sinus Tarsi Syndrome

What is the Sinus Tarsi?

The sinus tarsi is a small articulation on the outside of the ankle bone between two bones, the talus and calcaneus bone. The articular spacing between these two bones facilitates a small tunnel for blood vessels, nerve endings, ligaments, and tendons to pass through. 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

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 the action of running, and running shoes can lead to an overload of the outer ankle.

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 worse when turning the foot outwards. Low-level 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.

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

This involves the Therapist dorsiflexing and everting the foot while palpating the sinus tarsi. If this provokes the symptoms, then 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.

Picture of MRI Machine

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 for £45.