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. How do you detect sinus tarsi syndrome and how do you treat it?

What is the sinus tarsi? 

sinus tarsi syndrome

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, sinus tarsi ligaments, and blood vessels that can be damaged and cause pain. In general, we think that damage occurs after repeated ankle sprains or 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.
  • difficultly in walking on uneven surfaces
  • a feeling of instability of the ankle when walking
  • tenderness at the sinus tarsi

Often, symptoms should be differentiated from subtalar joint pain secondary to subtalar joint arthritis.

Generally, you need to see your doctor to confirm the diagnosis of sinus tarsi syndrome. It is important we rule out other causes of ankle pain. Examples include ankle joint arthritis, peroneal tendonitis, or lateral ligament sprain. Often, we use MRI to exclude these other causes. Sometimes, we see inflammation in the sinus tarsi on MRI.

Sometimes, 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

Sinus tarsi treatment.

Generally, we use simple sinus tarsi treatments.

Firstly, shoe selection is important. Many people with sinus tarsi syndrome have flat feet or overpronate. Shoes that support flat feet can make a big difference. Moreover, orthotics for sinus tarsi syndrome to support the medial arches can also help. Taping or bracing may be used by some podiatrists. A special ankle brace for sinus tarsi syndrome can be quite helpful.

Secondly, physiotherapy to improve strength, balance, and mobility of the ankle can reduce the load on the sinus tarsi.

In some cases, a cortisone injection directed into the sinus tarsi can reduce inflammation and pain.

Finally, surgery is reserved for difficult cases that fail simple treatments. Moreover, surgery can involve open (osteotomy) or keyhole (arthroscopy).

More on Sinus Tarsi injection

Generally, we perform sinus tarsi injections with cortisone. Cortisone is a powerful anti-inflammatory that reduces pain and improves function. Overall, we use a sinus tarsi injection when simple treatments fail.

Usually, a sinus tarsi injection is done under ultrasound-guidance to improve accuracy and effect. 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, subtalar joint injections are difficult to perform without ultrasound-guidance. Usually, injections into the subtalar joint can be performed 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 is important you rule out other causes by using imaging such as MRI. We often find that a sinus tarsi injection is effective when combined with other simple treatments.

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Dr. Masci is a specialist sport doctor in London. 

He specialises in muscle, tendon and joint injuries.

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