Sinus tarsi syndrome is a relatively common condition causing pain at the front and outside of the ankle. It’s 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 is a small tunnel that sits between the two parts of the subtalar joint in the ankle. It contains nerves, the sinus tarsi ligaments, and blood vessels, all of which can be damaged, causing pain. We believe the damage often follows repeated ankle sprains or results from biomechanical issues such as flat feet.
Sinus tarsi syndrome symptoms
Common symptoms of sinus tarsi syndrome are:
- Pain at the front and outer aspect of the ankle, often just below the ankle joint
- Difficulty walking on uneven surfaces
- A feeling of instability in the ankle when walking
- Tenderness over the sinus tarsi
These symptoms often need to be differentiated from subtalar joint pain caused by subtalar joint arthritis, which sits deeper in the joint below the ankle.
How is sinus tarsi syndrome diagnosed?
It’s best to see a doctor to confirm the diagnosis, because other causes of outer ankle pain must be ruled out — including ankle joint arthritis, peroneal tendonitis, a lateral ligament sprain, a high ankle (syndesmosis) sprain, and tarsal coalition.
We often use MRI to exclude these other causes, and sometimes it shows inflammation in the sinus tarsi. Occasionally, imaging reveals a sinus tarsi ganglion cyst, which can mimic sinus tarsi pain but is treated differently.
Sinus tarsi syndrome treatment
We use simple sinus tarsi syndrome treatments first.
Shoe selection is essential. Many people with sinus tarsi symptoms have flat feet or overpronate, so shoes that support flat feet make a big difference. Orthotics can also support the medial arch, and some podiatrists use taping or a supportive ankle brace, which can be helpful.
Physiotherapy to improve the ankle’s strength, balance, and mobility reduces the load on the sinus tarsi.
A cortisone injection directed into the sinus tarsi reduces inflammation and pain in some cases.
Surgery is reserved for complex cases that have failed simple treatments, and can involve an open (osteotomy) or keyhole (arthroscopy) approach. It’s regarded as a last resort.
More on the sinus tarsi injection
We perform sinus tarsi injections with cortisone — a potent anti-inflammatory that reduces pain and improves function — when simple treatments fail.
We inject under ultrasound guidance to improve accuracy and effectiveness, and to reduce side effects such as skin thinning and depigmentation.
Sometimes, where there’s subtalar joint arthritis, an injection into the subtalar joint is more effective. Subtalar joint injections are difficult to perform accurately without ultrasound guidance, and we usually inject from the outside or back of the ankle.
How much does a sinus tarsi injection cost?
Dr Masci performs the sinus tarsi injection as a one-stop appointment — consultation, diagnostic ultrasound, and the injection in a single visit. At the Chelsea clinic (the most cost-effective location), a consultation with an ultrasound-guided cortisone injection is £400; other clinic locations cost more. See the full one-stop injection fees here, along with our clinic locations.
Frequently asked questions about sinus tarsi syndrome
How long does sinus tarsi syndrome take to heal?
With the right treatment — physiotherapy, orthotics, and one or two cortisone injections — most people improve, usually over 3–6 months. Recovery is often quicker when flat feet or overpronation are addressed with the right footwear and orthotics.
How many cortisone injections can I have for sinus tarsi syndrome?
We’d be cautious about repeated injections. If one or two haven’t settled the pain, it’s usually better to focus on rehabilitation and good orthotics rather than keep injecting. Repeated cortisone injections into the same area carry their own risks.
Is surgery the next step if injections don’t work?
Not usually. Surgery for sinus tarsi syndrome is regarded as experimental and a last resort, considered only when rehab, orthotics, and injections have all been tried. Most people avoid surgery.
Can sinus tarsi pain be referred from elsewhere?
Sometimes. Pain around the outer ankle can occasionally be referred — for example, from the shin — so if pressing on your shin reproduces the ankle ache, it’s worth seeing a doctor to check the true source before treating the ankle alone.
What’s the difference between sinus tarsi syndrome and subtalar joint pain?
Sinus tarsi syndrome affects the small tunnel and its ligaments at the front and outside of the ankle, whereas subtalar joint pain (often from arthritis) comes from deeper within the joint below the ankle. They can feel similar, so imaging and, sometimes, a diagnostic injection help tell them apart — and the injection target differs.
Does sinus tarsi syndrome go away on its own?
Milder cases can settle with the right footwear, orthotics, and changes in activity. More persistent cases usually need physiotherapy and sometimes an injection — but the outlook is good, and most people recover without surgery.
Final word from Sport Doctor London about sinus tarsi syndrome
Sinus tarsi syndrome is a common cause of pain at the front and outside of the ankle. It’s important to rule out other causes with imaging, such as an MRI. A sinus tarsi injection is often effective when combined with simple treatments such as physiotherapy and orthotics.
If you have persistent outer ankle pain, Dr Masci can assess you in London, including an ultrasound in the clinic. Contact the team here or call +44 (0) 203 488 0350.
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