A small bony canal which runs into the ankle under the talus ankle bone, this syndrome is really a hole in the bony tissue in the middle of two bones, with the hind part of the foot beneath the ankle joint. The structures that are in between the two bones, will have also been sprained during a twisted out ankle joint strain. But at first, this will get missed, or will not be identified.
Pain can be difficult to pin point; however, it is somewhere just in front of the bony bit, or on the outside of the ankle and foot. Tenderness will be felt at the opening of the sinus tarsi, which is located on the outside of the ankle. It is a sharp sensation that can be compared to a pinching of the foot when toes are pulled close to the shin. Pains are experienced at the back of the foot and lead to instability in walking, especially on uneven ground. These pains are also experienced when walking up staircases.
Other symptoms and signs of this syndrome are:
• Tarsal pain increasing on the feet over time
• Tarsal pain located deep in the subtalar joint
• Tarsal pain that rises with forced inversion
• Pain that is comforted by rest.
The soreness of this syndrome is able to be palpated on the outside of the ankle joint in front of the lateral or external rear foot bone. The patient may have pain or difficulty running on a curve on the side of the painful ankle.
An ankle sprain or repetitive movements of the sinus tarsi from over pronation are the two reasons there is pain to this area. In turn, there’s traumatic injury, and irritation to the tissues.
Another cause of this syndrome is a pronated, or fallen foot. This may create difficulties when the ankle is stretched to its end range of flexibility. This type of bone tissue with bone pressure is very unpleasant.
Contributing Factors to the Development of Sinus Tarsi Syndrome
• poor flexibility
• inappropriate training
• poor foot biomechanics
• inappropriate footwear
• muscle weakness
Rest is needed from all painful activities. Continuing to train on a painful ankle will make the injury worse, or at the least, prevent healing. Apply ice or cold therapy to reduce pain and inflammation. Your GP may prescribe anti inflammatory drugs, while electrotherapy, such as ultrasound, may help reduce inflammation and swelling caused by this syndrome.
Mobilisation of the subtalar joint is an important part of treatment and rehabilitation. A professional therapist or trainer should be able to help with ankle mobilisations. Biomechanical problems such as over pronation should be corrected. Over pronation is when the foot flattens, or rolls in too much. This could change the way the ankle bones move, restricting the space in the sinus tarsi channel. A podiatrist or physiotherapist can prescribe orthotic insoles which go in shoes, to correct biomechanical foot problems. It is important to have the correct running shoes also.
Strengthening exercises for the ankle are critical. If you have been out of training on an injured ankle, then the coordination of the ankle will be disrupted. Balancing exercises can, and make, re-injuring the ankle less likely. The calf muscles at the back of the lower leg should be stretched, since if they are tight, the biomechanics of the ankle may be affected.
The symptoms of sinus tarsi syndrome may often be relieved with an injection of local anaesthetic in the sinus tarsi.
• An injection that is anaesthetic into a very painful sinus tarsi, will confirm the diagnosis, by getting rid of pain and allowing function to return to normal.
• A MRI test may identify unnecessary fluid in the sinus tarsi.
• Orthotics will not only support the foot, but correct over pronation too.
• Anti-inflammatory medications will also help.
Very infrequently, surgery is specified and if necessary, there are two (2) methods:
• Open surgery – through an incision
• Closed surgery – via arthroscopy
Outstanding outcomes should be anticipated; but remember, no surgery is a cure all, and should therefore be seen as a final option.
Your feet mirror your general health . . . cherish them!