If you’ve been experiencing discomfort in your ankle, you might be dealing with sinus tarsi syndrome. This condition, characterised by pain in the sinus tarsi, can affect your daily activities and mobility. At Advance Foot Clinic Podiatry, we understand the frustration that comes with persistent foot and ankle issues. In this comprehensive guide, we’ll delve into what sinus tarsi syndrome is, its symptoms, causes, and most importantly, effective sinus tarsi syndrome treatment options that can help you find relief.
What is Sinus Tarsi Syndrome?
Sinus tarsi syndrome refers to the inflammation or irritation of the sinus tarsi, a tunnel between the talus and calcaneus on the outside of the ankle. This area contains important ligaments and structures that support the foot and ankle, including the subtalar joint, where the interosseous ligament connects the talus to the calcaneus. The surrounding bones help guide movement and stability in this region. The subtalar joint includes anterior, middle, and posterior facet surfaces. When the sinus tarsi becomes inflamed, it can lead to pain, tenderness, and swelling in the ankle, particularly during weight-bearing activities.
Recognising the Symptoms of Sinus Tarsi Syndrome
If you’re unsure whether your ankle pain is due to sinus tarsi syndrome, here are some common symptoms to look out for:
Pain on the outside of the ankle: You may experience a dull ache or sharp pain in the area of the sinus tarsi, with pain located on the lateral side of the ankle or hindfoot.
Tenderness to touch: Pressing on the sinus tarsi may elicit discomfort or pain.
Swelling: Inflammation of the sinus tarsi can lead to visible swelling around the ankle joint, and it may sometimes feel like a lump under the skin near the sinus tarsi space between the ankle and heel.
Difficulty with weight-bearing activities: Walking or standing for prolonged periods may exacerbate the pain, sometimes causing difficulty walking, especially on uneven ground or uneven surfaces.
If you’re experiencing any of these symptoms, it’s essential to consult with a podiatrist for an accurate diagnosis and appropriate sinus tarsi syndrome treatment.
Magnetic resonance imaging, or MRI, is often used during differential diagnosis because it is the best way to visualise soft tissues in the sinus tarsi. Pinpointing the lateral opening of the tarsal sinus can help identify where symptoms are coming from for diagnosis. CT can help exclude bone fractures but does not diagnose the condition.
A diagnostic lidocaine injection may also be used, and pain relief after the injection supports the diagnosis.
Understanding the Causes
Several factors can contribute to the development of sinus tarsi syndrome:
Ankle sprains: A previous ankle injury, such as a sprain, is the most common cause and accounts for about 80% of cases, often leading to instability and increased stress on the sinus tarsi.
Overuse: Engaging in repetitive activities that involve the ankle, such as running or jumping, can strain the structures surrounding the sinus tarsi.
- Foot biomechanics: Issues with foot alignment or gait abnormalities can place excessive pressure on the sinus tarsi; flat or pronated feet and a flat alignment can compress the area, while high arches can also contribute.
- Synovitis is a common underlying pathology in sinus tarsi syndrome and is seen in many cases, occurring in about 70% of patients.
By identifying and addressing the underlying pathology, your podiatrist can develop an effective treatment plan to alleviate your symptoms and prevent recurrence.
Finding Relief with Physical Therapy and Sinus Tarsi Syndrome Treatment
Fortunately, there are several treatment options available to manage sinus tarsi syndrome and promote healing:
- Rest and Ice: Taking a break from activities that exacerbate the pain and applying ice to the affected area can help reduce inflammation and provide relief. Often a short period (1-2 weeks) is enough to break the inflammation cycle and cure the condition.
Orthotics: Custom orthotic inserts can correct foot biomechanical issues and provide support to the arch, opening up and relieving pressure on the sinus tarsi.
Physical Therapy: As part of conservative treatment, targeted exercises and stretches can improve flexibility, while subtalar joint glides help assess ankle stability and rehab may also include proprioceptive training and muscle strengthening exercises to reduce the risk of further injury.
Bracing: Wearing a brace or ankle support can provide stability to the ankle joint and prevent excessive movement that may aggravate symptoms, while stable shoes can offer added support during recovery.
Laser Therapy: Low-level laser therapy (LLLT) can be an effective adjunct treatment for sinus tarsi syndrome. This non-surgical approach may also be combined with ultrasound and anti inflammatory medication to support tissue healing, reduce inflammation in the affected area, and promote faster healing and pain relief.
Shockwave Therapy: Extracorporeal shockwave therapy (ESWT) is another option for treating sinus tarsi syndrome. This procedure involves delivering shockwaves to the affected area, stimulating the body’s natural healing response and reducing pain.
Steroid Injections: In some cases, corticosteroid injections may be recommended to reduce inflammation and alleviate pain in the sinus tarsi, although recurrence can occur and symptoms return within a year in many cases.
Laser Therapy for Sinus Tarsi Syndrome
Laser therapy, also known as low-level laser therapy (LLLT), has gained popularity as a treatment option for various musculoskeletal conditions, including sinus tarsi syndrome. This non-invasive approach utilises specific wavelengths of light to penetrate the skin and target the inflamed tissues in the sinus tarsi. If laser therapy and other conservative measures do not resolve chronic symptoms, subtalar arthroscopy may be considered and can provide pain relief. Reported clinical outcomes also note that six out of ten patients returned to sports after subtalar arthroscopy.
How Laser Therapy Works
During a laser therapy session, the podiatrist will use a handheld device to deliver the laser energy directly to the affected area. The light energy stimulates cellular metabolism and increases the production of adenosine triphosphate (ATP), which is essential for cellular repair and regeneration. Additionally, laser therapy helps to improve blood circulation and lymphatic drainage, which aids in the removal of toxins and reduces swelling.
One of the key benefits of laser therapy is its ability to provide pain relief without the need for medication or invasive procedures. Many patients experience significant improvement in their symptoms after just a few sessions of laser therapy.
Shockwave Therapy for Sinus Tarsi Syndrome
Extracorporeal shockwave therapy (ESWT) is another advanced treatment option for sinus tarsi syndrome. This non-invasive procedure involves the delivery of high-energy shockwaves to the affected area using a specialised device. The shockwaves create microtrauma within the tissues, stimulating the body’s natural healing response and promoting tissue regeneration. It is generally considered when ongoing symptoms follow ligamentous injuries or a ligament tear and contribute to subtalar instability.
Shockwave therapy has been shown to effectively reduce pain and inflammation associated with sinus tarsi syndrome. It can also improve blood flow to the affected area, facilitating the delivery of nutrients and oxygen essential for healing. In chronic cases, inflammation may involve scar tissue, synovial tissue, nerves, or other pathologic findings within the sinus tarsi, sometimes affecting the cervical ligament and related structures on the lateral side of the hindfoot.
Take Charge of Your Ankle Health at Advance Foot Clinic
Don’t let sinus tarsi syndrome hold you back from enjoying your daily activities. With the right approach to treatment and care, you can find relief from pain and get back on your feet. If you’re experiencing sinus tarsi pain or suspect you may have sinus tarsi syndrome, schedule an appointment with one of our experienced podiatrists at at one of our Brisbane or Mount Isa clinics. We’re here to help you take charge of your ankle health and get back to doing the things you love.