ATHLETIC EDGE
Sports Medicine
Sports Injury Prevention & Rehabilitation
 540 BRYANT ST, PALO ALTO, CA 94301
(650) 815-6552

Voted Best Sports Therapy Clinic in the San Francisco Bay Area 2010-2016!

Sinus Tarsi Syndrome

What is sinus tarsi syndrome?
The sinus tarsi is a small cavity located on the outside of the ankle between the talus and calcaneus bones. This cavity contains numerous anatomical structures including ligaments and joint capsule. These structures may be injured following an ankle sprain or due to the repetitive strain associated with an excessively pronated (flat) foot. When this occurs, the condition is known as sinus tarsi syndrome.

Cause of sinus tarsi syndrome
Sinus tarsi syndrome usually occurs following an ankle sprain or due to the repetitive strain associated with walking or running on an excessively pronated (flat) foot.

Signs and symptoms of sinus tarsi syndrome

Patients with sinus tarsi syndrome typically experience pain over the outside of the ankle. There may also be swelling and tenderness in the region. Symptoms are typically worse in the morning and may present as pain and stiffness that slowly improves as the patient warms up. Symptoms may also be aggravated during walking or running especially on slopes or uneven surfaces.

Treatment for sinus tarsi syndrome
The vast majority of patients with sinus tarsi syndrome heal well with an appropriate rehabilitation program. The success rate of the program is largely dictated by patient compliance. One of the key components is that the patient rests sufficiently from ANY activity that increases their pain until they are symptom free (crutches may be required). This allows the body to begin the healing process in the absence of further tissue damage. Once the patient can perform these activities pain free, a gradual return to these activities is indicated provided there is no increase in symptoms.
Ignoring symptoms or adopting a 'no pain, no gain' attitude is likely to lead to the condition becoming chronic. Once chronic, healing slows significantly resulting in markedly increased recovery times and an increased likelihood of future recurrence. Immediate appropriate treatment in all patients with this condition is vital to ensure an optimal outcome.
Following RICE with regular icing and anti-inflammatory medication may help to significantly reduce inflammation in the initial phase of this condition. A graduated flexibility, balance and strengthening program under direction from a physiotherapist is vital to ensure an optimal outcome.
In the final stages of rehabilitation, a gradual return to activity or sport should occur under guidance from the treating practitioner and provided symptoms do not increase.

Contributing factors to the development of sinus tarsi syndrome

There are several factors which can predispose patients to developing this condition. These need to be assessed and corrected with direction from a therapist and may include:
  • poor flexibility
  • inappropriate training
  • poor foot biomechanics
  • inappropriate footwear
  • muscle weakness

Physical therapy for sinus tarsi syndrome

Physical therapy treatment is vital to hasten the healing process, ensure an optimal outcome and reduce the likelihood of injury recurrence in all patients with this condition. Treatment may comprise:
  • soft tissue massage
  • electrotherapy (e.g. ultrasound)
  • anti-inflammatory advice
  • joint mobilization
  • taping
  • bracing
  • the use of crutches
  • ice or heat treatment
  • exercises to improve strength, flexibility and balance
  • education
  • activity modification advice
  • biomechanical correction
  • footwear advice
  • a gradual return to activity program
Prognosis of sinus tarsi syndrome
Most patients with this condition heal well with an appropriate rehabilitation program. This, however, can be a lengthy process and may take several months in patients who have had their condition for a long period of time. Minor cases of this condition that are identified and treated early can usually settle within a few weeks. Early treatment is vital to hasten recovery and ensure an optimal outcome.

Other Intervention for sinus tarsi syndrome
Despite appropriate therapy management, a small percentage of patients with this condition do not improve adequately. When this occurs the treating doctor can advise on the best course of management. This may involve further investigation such as an X-ray, Ultrasound, CT scan or MRI, corticosteroid injection, pharmaceutical intervention or a review by a specialist who can advise on any procedures that may be appropriate to improve the condition. A review with a podiatrist for the prescription of orthotics and appropriate footwear advice may also be indicated.