Sinus tarsi syndrome is a relatively common condition causing pain at the front and outside of the ankle. Generally, it is often confused with other ankle conditions, such as lateral ligament sprains or subtalar joint pain. So, how do you detect sinus tarsi syndrome, and how do you treat it?
What is the sinus tarsi?
The sinus tarsi anatomy is a small tunnel that sits between the two parts of the subtalar joint in the ankle. This small tunnel contains nerves, the sinus tarsi ligaments, and blood vessels that can be damaged, causing pain. We believe that damage often occurs after repeated ankle sprains or the presence of biomechanical abnormalities, such as flat feet.
Sinus tarsi symptom checker
Overall, common symptoms of sinus tarsi syndrome are:
- Pain at the front and outside aspect of the ankle. Often, the pain is just below the ankle joint.
- Difficulty walking on uneven surfaces
- A feeling of instability of the ankle when walking
- tenderness at the sinus tarsi
Often, symptoms should be differentiated from those associated with subtalar joint pain secondary to subtalar joint arthritis.
Generally, it would be best if you saw your doctor to confirm the diagnosis of sinus tarsi syndrome. We must rule out other causes of ankle pain. Examples include ankle joint arthritis, peroneal tendonitis, and lateral ligament sprain or tarsal coalition. Often, we use MRI to exclude these other causes. Sometimes, we see inflammation in the sinus tarsi on MRI.
Occasionally, we find a sinus tarsi ganglion cyst on imaging. A sinus tarsi ganglion cyst can mimic sinus tarsi pain but is treated differently.
Sinus tarsi syndrome treatment
Generally, we use simple treatments for sinus tarsi syndrome.
Firstly, shoe selection is essential. Many people with symptoms of sinus tarsi have flat feet or overpronate. Shoes that support flat feet can make a big difference. Moreover, orthotics for sinus tarsi syndrome can also help support the medial arches. Taping or bracing may be used by some podiatrists. A special ankle brace for sinus tarsi syndrome can be pretty helpful.
Secondly, physiotherapy to improve the ankle’s strength, balance, and mobility can reduce the load on the sinus tarsi.
A cortisone injection directed into the sinus tarsi can reduce inflammation and pain in some cases.
Finally, surgery is reserved for cases that are complex and have failed simple treatments. Moreover, surgery can involve an open (osteotomy) or keyhole (arthroscopy).
More on Sinus Tarsi injection
Generally, we perform sinus tarsi injections with cortisone. Cortisone is a potent anti-inflammatory that reduces pain and improves function. Overall, we use a sinus tarsi injection when simple treatments fail.
Typically, we perform a sinus tarsi injection under ultrasound guidance to enhance accuracy and effectiveness. Also, injecting under ultrasound reduces side effects such as skin thinning and depigmentation.
Sometimes, if you have subtalar joint arthritis, an injection into the subtalar joint could be more effective. Generally, performing subtalar joint injections is challenging without ultrasound guidance. Typically, we administer injections into the subtalar joint from the outside or the back of the ankle.
Final word from Sportdoctorlondon
Overall, sinus tarsi syndrome is a common cause of pain at the front and outside of the ankle. It would be best to rule out other causes using imaging such as MRI. We often find that a sinus tarsi injection is effective when combined with other simple treatments.
How long it takes to heal from sinus tarsi syndrome?? What conservative management is available and is it effective?
hi Midhat, Generally for sinus tarsi syndrome, I recommend physio, orthotics, and one or two cortisone injections. Generally, most patients feel better after one or more of these treatments. Benefits are often seen after 3-6 months.
Lorenzo
I fell and was diagnosed with sinus tarsi syndrome. It has been 8 months and 2 injections since seeing a podiatrist. How many injections will it take to recover? I have been in pain for so long.
I assume you’ve had imaging. I’d be cautious about more injections. I’d suggest rehab and good orthotics.
Does it make sense that I can recreate the aching in the ankle area by pressing firmly on an area of my shin? I am trying to decide whether to see a doctor or if it may be referred pain from shin muscle.
You might have referred pain from the shin bone. I’d suggest seeing a doctor if you’re pain persists.
I have had this ongoing for years now, have had two cortarol injections but didnt seem to work, is the next process surgery? also i get a shooting pain if i try to kick a ball or run and land heavily on it. is this also due to having sinus tarsi syndrome?
surgery for sinus tarsi is experimental and only indicated if you’re tried all other treatments as discussed in the blog – rehab, orthotics and injections