When treated early, recovery from sinus tarsi syndrome is quite quick but without appropriate, early intervention it can lead to chronic pain. Accurate diagnosis is often missed. nyone with persistent pain and instability, particularly if they have previously sprained their ankle, should be thoroughly assessed for this condition.
Here we will look at what the sinus tarsi is, what causes sinus tarsi syndrome, the symptoms of the condition, how it is diagnosed and the best treatment options.
The sinus tarsi is a small cylindrical cavity found on the outside part of the hindfoot. It sits between the talus and calcaneus (heel bone), an area known as the subtalar joint.
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A number of ligaments, blood vessels and nerves pass through the sinus tarsi. It plays an important role in balance and proprioception. Inflammation around this region or injury of any of the surrounding ligaments results in Sinus Tarsi Syndrome.
Sinus tarsi syndrome is rare condition, usually caused by instability of the subtalar joint in the ankle. The two most common causes of subtalar instability are:
Symptoms of sinus tarsi syndrome tend to come on gradually over time. If you have injured the ankle, the symptoms of the initial injury tend to never fully settle, so even though the injured ligament heals properly, you are left with pain due to the resultant irritation of the sinus tarsi area.
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An MRI scan is the best way to see what is going on in the sinus tarsi structures. It will show any inflammation and fibrosis in the area.
Another common diagnostic tool is to inject the sinus tarsi region with local anaesthetic and corticosteroids. Cessation of symptoms (i.e. they go away) indicates a positive diagnosis of sinus tarsi syndrome. The effects of the injection are usually short lived and further treatment will be required.
When diagnosed early, a full recovery can be made in just a few weeks. However, if the problem is not addressed in the early stages, or if a rehab programme is not adhered to, sinus tarsi pain can become a chronic problem taking months to settle down.
Ankle Sprain Guideline
Rest is essential with Sinus Tarsi Syndrome. Any activities which triggers the sinus tarsi pain needs to be avoided to allow time for the tissues to heal. This may require the use of crutches and or an ankle brace in the short term. The most common cause of prolonged pain from sinus tarsi syndrome is failure to rest for aggravating activities.
Applying ice regularly helps to reduce pain and inflammation. Ice massage is particularly useful here as it closely targets the sinus tarsi region. Visit the Ice Treatment section to find out how to use ice safely and effectively.
Regular physiotherapy helps to address the cause of sinus tarsitis, be it hypermobility of the subtalar joint or altered foot biomechanics which in turn reduces the symptoms. It may include:
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Supportive footwear to restrict excessive rear foot movement rather than open backed shoes can be helpful. If you have abnormal foot biomechanics such as flat feet, you might also be recommended to try orthotics such as shoe inserts to correct this.
Exercises should only be started once sinus tarsi pain has settled. It is fine to exercise the other muscles of the leg, but ankle exercises should be avoided until they are pain free.
Once the symptoms have settled down, you can start gradual stretching exercises, particularly concentrating on calf stretches, and strengthening exercises for the calf, ankle and foot muscles.
Sinus Tarsi Syndrome (sts)
Once sinus tarsi syndrome symptoms have subsided, you can gradually return to your usual activities. It is important to pace yourself and not try to do too much too soon, or you may flare the condition up again.
Whilst rarely necessary, if the symptoms of sinus tarsi syndrome fail to settle using these methods, surgery is required. This may be to remove any chronic synovitis (inflammation) and scar tissue, reconstruction of the ligaments or arthrodesis – fusion of the subtalar joint.
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Sinus Tarsi Syndrome is rare and there are a number of other causes of pain on the outside of the ankle/foot region. For more help working out what is wrong, visit the Side Foot Pain diagnosis section or if your symptoms are more widespread, the foot pain diagnosis overview.
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3 days ago I thought I was going to need foot surgery. I NEVER thought that stretching my calf would relieve the excruciating pain at the top of my foot. Thank you!!
The material on this website is intended for educational information purposes only for the general public. It should not delay or substitute medical advice, diagnosis or treatment.Jeffrey A. Oster, D.P.M. reference presentation true The Foot and Ankle Knowledgebase , L.L.C. , L.L.C. , L.L.C. 2000 https:///about http://creativecommons.org/licenses/by-nc/3.0/deed.en_US en-US Sinus Tarsi Syndrome | Causes and treatment options sinus tarsi syndrome, sinus tarsitis Sinus tarsi syndrome - learn about the symptoms and treatment recommendations - part of the Foot and Ankle Knowledge Base. /sinus-tarsi-syndrome https:///images/thumbs/0001485_sinus-tarsi-syndrome.jpeg https:///images/thumbs/0001485_sinus-tarsi-syndrome.jpeg
Sinus tarsi syndrome is an inflammatory reaction found within the sinus tarsi. The sinus tarsi is the lateral entry point to the subtalar joint. The subtalar joint consists of the talus on the top and the calcaneus (heel bone) on the bottom. Sinus tarsi syndrome is also referred to as sinus tarsitis. The onset of sinus tarsi syndrome is often preceded by trauma to the subtalar joint. Trauma may be due to an ankle sprain or a fall. In addition to a traumatic onset, sinus tarsi syndrome may also be due to chronic inflammatory conditions of the subtalar joint. Chronic inflammatory tissue can result from arthritis or cyst formation within the sinus tarsi or adjacent subtalar joint. Sinus tarsi syndrome is found equally in men and women. Sinus tarsi syndrome is found in adults between the ages of 18 to 50 years of age.
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First described in 1958 by O’Conner, sinus tarsi syndrome was initially thought to be due to post-traumatic scarring. The onset of sinus tarsi syndrome usually occurs in the second or third decade of life. Most contemporary clinicians believe that sinus tarsi syndrome is due to a repetitive, traumatic load applied to the subtalar joint, resulting in forced inversion of the joint. Examples of repetitive inversion activities that would injure the subtalar joint include the trailing foot of a softball pitcher or bowler. Other examples include sitting with the feet tucked under the weight of your body. Each of these activities results in forced inversion of the subtalar joint and strain on the sinus tarsi.
Forced eversion of the subtalar joint can also contribute to the onset of sinus tarsi syndrome. Ballet is a good example of an activity that results in forced eversion of the subtalar joint. Each of the four positions of ballet results in one or both of the feet being placed in a position where the subtalar joint is in forced eversion, placing strain on the sinus tarsi. This strain on the sinus tarsi results in sinus tarsi syndrome.
The sinus tarsi is a cone-shaped area that lies between the talus to the top and calcaneus to the bottom. The sinus tarsi actually refers to the entry of the canalis tarsi, or deeper portion of the sinus. The canalis tarsi consists of the calcaneal portion called the sulcus calcanei. The dorsal or talar portion of the canalis tarsi is called the sulcus tali. The canalis tarsi separates the two segments of the subtalar joint. The subtalar joint consists of three different joint facets that are separated by the canalis tarsi. The anterior and middle facets lie distal to the canalis tarsi. The posterior facet lies proximal to the canalis tarsi.
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The subtalar joint is held together by both internal supporting structures and external structures that traverse the joint. The cervical ligament, also known as the ligament of Farabeu, lies within the sinus tarsi. Deeper to the cervical ligament is an interosseous ligament that connects the talus and calcaneus. Both the cervical ligament and interosseous ligaments help to stabilize the subtalar joint during pronation (flattening of the foot) and supination (increasing the arch of the foot.) The bifurcate ligament also originates in the sinus tarsi and extends across the top of the foot to the medial aspect of the foot. The bifurcate ligament is a two-part, or Y shaped retinacular band that inhibits supination and prevents the extensor tendons on the top of the foot from bow stringing. A fatty plug lies within the sinus tarsi. This fatty material is called Hoke's tonsile. Additional soft tissue found within the sinus tarsi includes the synovium of the subtalar joint.
Numerous small nerve endings are found in the canalis tarsi and are extensions of the posterior tibial nerve. Studies have shown that the nerve endings in the canalis tarsi are a source of nociceptive (pain) and proprioceptive (space orientation) neural sensation. Strain applied to the nerve endings of the sinus tarsi will stimulate a proprioceptive response and will initiate splinting of adjacent muscles and tendons in an attempt to limit excessive motion of the subtalar joint.
Compression of the tissues within the sinus tarsi occurs as the foot pronates (flattens). Testing has found that pronation significantly increases
