The sinus tarsi is a small, hollow canal that begins on the outside of the foot between the ankle bone (the talus) and the heel bone. A number of ligaments, blood vessels, and nerves pass through the sinus tarsi cavity.
The sinus tarsi is important because it plays an essential role in your balance and in the body’s ability to sense movement within joints and joint position.1
Inflammation around the sinus tarsi, or injury of its surrounding ligaments, can result in sinus tarsi syndrome… which is not good news.
What is Sinus Tarsi Syndrome?
Sinus tarsi syndrome is a common foot injury, especially for those who play a lot of stop-and-go sports.
It usually appears as pain on the outside of the ankle.
It can occur after an injury to the main ligaments of the “subtalar joint” of the foot. Such an injury can cause instability or hypermobility in the joint which results in an excessive rolling of the foot (what is known as either a pronation or inversion, depending on which way the foot rolls).
Some of these ligaments run right through the sinus tarsi canal, or the instability may place stress on the sinus tarsi, creating inflammation and pain. This inflammation may also fill the sinus tarsi cavity with fluid and scar tissue.2
What are the symptoms of Sinus Tarsi Syndrome?
The symptoms of Sinus Tarsi Syndrome include –
- Pain along the front and sides of the ankle
- A feeling of instability in the foot or ankle
- Bruise-like discoloration
- The region becomes tender to the touch.
You should also know that prolonged standing and other weight-bearing activities will usually aggravate the injury. And, patients with Sinus Tarsi Syndrome will often struggle on uneven surfaces like grass and gravel.
The most common causes of sinus tarsi syndrome are ankle sprains, ongoing ligament instability, and poor foot biomechanics.3
What Can I Do If I Have This?
If you think that you might be suffering from sinus tarsi syndrome you should visit a physical therapist or podiatrist as soon as possible. First, your healthcare professional may need to run an x-ray, CT scan, or MRI.
TIP: An MRI is the best method for capturing the sinus tarsi and its surrounding ligaments.
A professional diagnosis is important as this will ensure the correct treatment for this particular condition, which can differ from other common foot and ankle issues. From here a specialist will design a rehabilitation program that suits your degree of injury.
Treatments vary greatly depending on the severity of the injury but may include –4
The use of ice, as well as ice massage, assists in the minimizing of pain and inflammation
Bracing or taping the foot
Strapping the injury may help to control or reduce the amount of rolling through the joint when you’re walking or exercising.
A course of nonsteroidal anti-inflammatory medications (NSAIDS) like ibuprofen or aspirin may be helpful in controlling inflammation, though these can be harmful if taken as a long-term solution.
A steroid, or cortisone, injection into the sinus tarsi can effectively target inflammation
Therapy focusing on balance and sense training alongside muscle strengthening exercises can assist in retraining the muscles and ligaments to support the area.
A foot orthotic is contoured to an individual’s foot and sits within the shoe like an insole to reduce abnormal motions or positions. This can effectively correct foot biomechanics and has shown to be very successful in reducing symptoms.
Though rare, if the rehabilitation process fails to fix the problem long-term, a patient may require a reconstruction of the subtalar joint.
Are You Wearing the Right Shoes?
Of course, there are things you can do to help prevent sinus tarsi, like making sure you wear the right shoes. What do podiatrists recommend? Well, purchasing new athletic shoes – even if you’re not an athlete – is a great place to start.
Your shoes should include –
- a straight last (athletic shoes built on a straight last offer motion control)
- a firm heel counter (to cradle the heel, reduce over-pronation and anchor the foot)
- a rigid material through the midsole
The use of a foot orthosis together with a sturdy athletic shoe is regarded as an even better combination. Though a regular reassessment of the shoe and the orthosis is needed in order to provide ongoing support.
Attain, Maintain, and Sustain
One of the key components of treatment for sinus tarsi syndrome is physical therapy. A physical therapy program is most often a multiphase process which will gradually build as the injury heals.
The key components in treating sinus tarsi syndrome with physical therapy are known as…
Attain – This phase deals with balance and uses basic postures that the patient should be able to still perform in a stable manner.
Maintain – This phase develops contractions of the muscles that cross the subtalar joint.
Sustain – This phase involves integrating all of the systems needed for stability during sports specific activities.
Recovery Time For Sinus Tarsi Syndrome
Minor cases of sinus tarsi syndrome may take anywhere from four to six weeks for a complete recovery and a return to normal activities. It is essential however to complete physical therapy properly. Chronic cases may take anywhere between six to nine months for a complete recovery.
Putting Your Best Foot Forward
If you’re in constant pain from either an ankle injury or recurrent ankle pain, it is definitely worth seeking out a professional diagnosis, as sinus tarsi syndrome does require a specific treatment plan.
However, it’s important to note that sinus tarsi syndrome is a common affliction and sometimes it’s simply the foot biomechanics that we’re all born with that are to blame. Nine out of twelve people with recurring ankle sprain injuries end up with an injury to the subtalar ligaments – and it’s very often sinus tarsi syndrome.5
But, with a professional treatment plan, physical therapy, supportive shoes, and orthotic insoles – both athletes and non-athletes have successfully been able to re-stabilize the subtalar joint and the sinus tarsi in order to walk, run, and skip happily ever after.