Sinus tarsi syndrome describes a painful disorder marked by swelling on the outer lower area of the ankle. It primarily affects the subtalar joint, where the anklebone (talus) connects with the heel bone (calcaneus). This condition arises from irritation of the tissue in the sinus tarsi, which can result in swelling. Also, the increased strain in this small space triggers pain. An ankle sprain is the primary cause of sinus tarsi syndrome, particularly in those who have experienced multiple sprains in the same ankle.
Symptoms
The main symptoms associated with sinus tarsi syndrome are:
Ankle pain and swelling that is more noticeable on the lower outer side of the ankle and can radiate to other parts of the ankle.
The swelling between the heel bones and ankle that may become so pronounced that it looks like a lump or cyst beneath the skin.
A persistent dull ache that intensifies into sharper or stabbing pain when moving the foot. This usually happens during situations such as:
Turning the foot in or outward.
Running, walking, or climbing stairs.
Pressing or touching the area near the sinus tarsi.
Causes
Sinus tarsi syndrome is usually caused by any injury or disorder that affects the sinus tarsi or the subtalar joint. The most common causes are:
Ankle sprains: Most cases of sinus tarsi syndrome stem from ankle sprains, mainly those where the ankle rolls outward. This sprain can also lead to synovitis in the subtalar joint, contributing to the condition.
Non-injury factors: Some conditions, as well as the natural foot structure, may gradually put extra pressure on the sinus tarsi, causing the syndrome. These factors include:
Flat feet
Overpronation when walking or running
Obesity
Arthritis in the ankle and foot
Risk Factors
While sinus tarsi syndrome can affect anyone, the risk is higher for persons who:
Participate in sports involving sudden twists and directional changes, like basketball, football, or hockey.
Engage in physical labor or regularly stand on solid surfaces.
Are pregnant. Pregnancy may contribute to overpronation.
Have had multiple sprains of the same ankle because frequent injuries increase the risks of the sinus tarsi syndrome.
Diagnosis and Testing
At The Joint Pain Clinic, we often diagnose Sinus tarsi syndrome through a physical exam, which may include:
Examining the affected ankle for signs of swelling.
Palpating the sinus tarsi area to look for tenderness.
Evaluating how the patient stands, walks, or moves the ankle. You may also be asked about when the symptoms started and any previous injuries.
In order to confirm the diagnosis and exclude other potential conditions, we may recommend these imaging tests:
X-ray: To examine the foot and ankle structure of the bone.
MRI: To evaluate soft tissues and identify any inflammation.
CT scan: To obtain detailed pictures of bones and soft tissues.
Management and Treatment
The goal of treating sinus tarsi syndrome is to minimize swelling and manage pain. Our common treatment options include:
Over-the-counter pain medications: NSAIDs or paracetamol can help relieve pain and inflammation.
Corticosteroids: Cortisone injections, which are prescription anti-inflammatory drugs, may be directly injected into the subtalar joint for targeted relief.
Immobilization: Using an ankle brace or walking boot can stabilize the ankle and provide support during the healing process. Taping the ankle may also give extra stability.
Physiotherapy: A physiotherapist can suggest appropriate stretches and exercises aimed at strengthening the ankle muscles and restoring movement.
Orthotics: Customized or over-the-counter shoe inserts improve feet and ankle support. Your doctor may also advise you on a particular kind of footwear.
Surgery: While this is rarely necessary, surgery might be an option if other conservative treatments do not effectively relieve severe pain and swelling.
Preventing Sinus Tarsi Syndrome
Preventing sinus tarsi syndrome may sometimes be inevitable, especially if you are an athlete. However, you can lower the risk by implementing these preventive measures:
Wearing the right protective gear along with suitable footwear, when engaging in sports or physical activity.
Discontinuing your exercise if the ankle is in pain.
Giving your ankles adequate rest and recovery time following intense physical activity.
Warming up and stretching before exercise; cooling down with stretches afterward.
Overall injury prevention tips involve:
Ensuring that living and working areas are tidy to prevent tripping hazards.
Using proper tools when reaching high places instead of standing on unstable surfaces such as chairs or countertops.
Opting for mobility aids, such as a cane or walker, if walking becomes hard or if there’s a higher risk of falling.
