What is sinus tarsi syndrome?

Sinus Tarsi Syndrome is a finding, mainly clinical, of pain and tenderness on the outside of the ankle, between the ankle and the heel. The sinus tarsi is a small cavity between the ankle bone (talus) and heel bone (calcaneus). The cavity contains numerous structures including ligaments which support the ankle. These structures can be injured during ankle sprains or from repetitive stress associated with flat feet (over pronated).

Causes of sinus tarsi syndrome?

Sinus Tarsi Syndrome can occur from a single traumatic event or a series of ankle sprains which results in damage to the structures in and around the sinus tarsi. Repetitive stress to these structures may also result in pain and this often occurs in people with flat feet (over pronated) during prolonged periods of walking or running.

Signs and Symptoms Symptoms of sinus tarsi syndrome 

Symptoms of sinus tarsi syndrome may include:

  • Pain, aching, tenderness at the location of the sinus tarsi, on the outside of the ankle.
  • Swelling
  • Increase pain with prolonged walking or running, especially on uneven surfaces
  • Grinding or impinging feeling in the ankle
  • Pain on excessive ankle movement.

Our treatment of sinus tarsi syndrome 

A comprehensive clinical examination of the affected foot is undertaken to assess for possible causative and aggravating factors, the severity of the condition, and suitable treatment options. Diagnostic imaging such as X-rays may also be ordered.

From these findings, a treatment plan is developed specifically for you. Some aspects of the treatment plan may include:

  • Activity modification. An initial change to your exercise regime or daily activities may be needed to avoid the condition getting worse. The introduction of a low impact alternate activity may also be of benefit such as swimming.
  • Ice. to ease pain and swelling. Do it for 20-30 minutes every 3 to 4 hours for 2 to 3 days, or until the pain is gone.
  • Anti-inflammatory. Nonsteroidal anti-inflammatory drugs (NSAIDs), like ibuprofen, naproxen, or aspirin, will help with pain and swelling as per GP instructions.
  • Strengthening/Isometric loading. It is important that strength is addressed for this condition so that the affected area can tolerate more load. This is done initially with isometric loading to load up the affected area in a pain-free way.
  • Injection therapy. Injections of a local anaesthetic can provide pain relief, and an injected corticosteroid may be useful in treating the inflammation.
  • Orthotic TherapyA custom orthotic device placed in the shoe can help address possible causative factors such as flat feet to reduce stress on the sinus tarsi.
  • Adequate footwear. Supportive footwear may also be recommended to stabilise the foot and ankle.
  • Taping/Bracing. Taping or bracing can help to stabilise the foot and ankle and reduce excessive stress on the sinus tarsi.

Surgery for sinus tarsi syndrome

In cases that are non-responsive to conservative treatment, surgical intervention may be required.