Sinus Tarsi Syndrome

On the outside of your ankle, you have a small, hollow space or cavity between one of the bones of the ankle (the talus) and the heel bone (calcaneus). This space is called the sinus tarsi. Inside this space run a number of nerves, ligaments and blood vessels as they travel down the leg to get to the foot. Sinus tarsi syndrome is a condition where the structures that pass through the sinus tarsi become inflamed or damaged. Any inflammation and swelling then takes up further space in the area, compressing the other structures further and producing more symptoms.

The symptoms of sinus tarsi can range depending on the extent of the damage and inflammation, and the level of nerve involvement, but can include:

• Pain and tenderness on the outside the ankle (in the area of the sinus tarsi), which may occasionally feel like a pinching sensation
• Pain that is worsened when notably rolling the foot out and in
• Swelling at the outer ankle
• Burning, numbness or tingling radiating from the area if nerves are being compressed within the sinus tarsi
• Ankle instability or weakness when walking 
• Pain and difficulty walking on uneven surfaces, like over rocks
• Symptoms that are exacerbated by physical activity, including standing and walking, which grow worse the longer you stay active

We typically see two common methods of injury when it comes to sinus tarsi syndrome. The first is through overusing the foot and placing excess stress on the region of the sinus tarsi. We often see this related to repetitive running, jumping and dancing sport involvement paired with a flatter foot type that can increase the stress on the outer ankle with every step. The second common cause is through ankle sprains, which can damage the structures inside the sinus tarsi. Repetitive ankle sprains can also lead to chronic ankle instability, which can add further stress and strain to the ankle and sinus tarsi, contributing to the problem and its recurrence.

Other contributing factors to the development of sinus tarsi syndrome can include:

• Shoes that do not offer sufficient support to your foot or help stabilise the ankle can contribute to sinus tarsi syndrome
• Other injuries to the foot and ankle, such as a direct blow to the outer ankle
• Muscle weakness or poor flexibility
• Poor training techniques or a poor training schedule that has you overdoing it on your feet
• Conditions like posterior tibial tendon dysfunction (PTTD), which is a key cause of flat feet in adults, can often be a precursor to sinus tarsi syndrome

To help ease your ankle pain and start your path to healing and repair at home before you get in to see your podiatrist, you can try:

• Icing your outer ankle (through a towel or cloth to protect the skin) for no more than 15 minutes at a time, four times per day. This may help reduce your pain and inflammation. You can also keep your ankle elevated to help promote swelling reduction.
• Using a compression bandage or sleeve around the ankle to help support the area and reduce swelling. At your appointment with us, we can also show you how to strap your ankle at home to help give you greater relief.
• Switching to good, supportive footwear - such as good joggers with a strong heel counter that holds your ankle in place well, and limits unwanted side-to-side movement. In this case, any light or barefoot sneakers are not suitable as they generally do not offer the required level of support. 
• Using non-steroidal anti-inflammatories (NSAIDs) as needed to help relieve pain and swelling
• Avoiding physical activity that aggravates and worsens your symptoms

Here at Matt Raden Podiatry, our trusted and experienced podiatrists listen to the concerns, goals and needs of our patients with foot and ankle pain, and utilise a range of evidence-based treatment methods to help you get the best outcome.

Every appointment starts with a comprehensive assessment to understand the biomechanics of your ankles, feet and legs, and all of the factors that are playing a role in overloading your peroneals and contributing to your pain. We’ll then create a tailored treatment plan based on your results that focuses on helping to heal and repair the tendons, and regaining ankle strength and function so you can stay active long into the future. We may use:

• Strapping your ankle to discourage it from excessively rolling outwards or inwards, which would place more pressure on the structures within the sinus tarsi and aggravate your symptoms. We can also teach you how to continue to strap your ankle at home.
• Bracing your ankle temporarily to keep the ankle in an ideal position to allow optimum healing and recovery to begin
• Orthotics (insoles): using custom-prescribed foot orthotics that sit inside your shoe can help provide some much needed stability and support for your ankle. Depending on the severity of your symptoms and if you have other concurrent issues like chronic ankle instability, your orthotics may have special features like a higher later (outer) raised side to significantly reduce any outwards ankle rolling, keeping your ankle situated in a much better position for healing and repair. Good arch support will also help keep your sinus tarsi in an ideal position.
• Footwear recommendations: wearing unsupportive shoes that let your ankles roll around will work against the recovery progress you are making by allowing further stress on the structures within the sinus tarsi. We will assess the footwear you currently wear on a daily basis (please bring these to your appointment) and will make recommendations as needed. This may include temporarily wearing your supportive shoes inside your home.
• Stretching and strengthening program: after some healing has occurred, it will be time to start on a specialised stretching and strengthening program, which will be developed based on the results of your assessment with us. Your program will focus on improving ankle strength and range of motion, with the goal of offering you both symptom relief now, and helping prevent the problem from recurring in the future.

Surgery is generally not required for sinus tarsi syndrome as the condition usually responds well to the non-surgical treatment methods we’ve outlined, plus any surgery carries significant risks. Cortisone injections, however, may be useful in some cases in helping to temporarily alleviate the pain and inflammation, which can allow you to comfortably focus on your rehabilitation for long-term management and prevention.