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What is sinus tarsi syndrome?
Causes and risk factors
Symptoms
Diagnosis
Treatment
Prevention
FAQs

Sinus tarsi syndrome is a leading cause of pain on the outside of the ankle that may present with burning, numbness, tingling and ankle weakness.

What Is Sinus Tarsi Syndrome?

To best understand what sinus tarsi syndrome is, you should know that on the outside of the ankle, you have a small, hollow space that runs between the ankle (specifically the talus bone) and the heel bone (calcaneus). This space is called the sinus tarsi. Passing through this space are nerves, ligaments and blood vessels, which travel down the leg to get to the foot. Sinus tarsi syndrome is a condition where these structures that pass through the sinus tarsi space become inflamed or damaged. Any resulting inflammation and swelling then takes up further space in the area, compressing the other structures further and producing more symptoms.

Sinus Tarsi Syndrome Causes And Risk Factors

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 sports, 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 leaves the ankle in a weakened state that adds greater strain on the ankle and sinus tarsi as you walk, contributing to the development and recurrence of sinus tarsi syndrome.

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

• Shoes that don’t offer sufficient support or stability around the heel and ankle
  
• Sustaining injuries to the foot and ankle, or experiencing trauma like getting hit with a ball on the outside of the foot
  
• Having weakness in the muscles surrounding the foot and ankle
  
• Having muscle imbalances or tightness that restricts movement around the foot and ankle
  
• Not using the right form or techniques when training, or having a poor training schedule that means you end up overdoing it on your feet
  
• Developing conditions like posterior tibial tendon dysfunction (PTTD), which is a key cause of flat feet in adults, which is often a precursor to sinus tarsi syndrome
  

Sinus Tarsi Syndrome Symptoms

The symptoms of sinus tarsi syndrome can range depending on the extent of the damage, 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 notably worsened when 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
  

Diagnosing Sinus Tarsi Syndrome

Our podiatrists can confidently diagnose sinus tarsi syndrome by carrying out a comprehensive biomechanical assessment. We’ll look for symptoms and swelling in the region of the sinus tarsi, neurological symptoms such as numbness and burning, as well as generalised ankle weakness. If we suspect that there may have been multiple structures damaged at the outer ankle, or need to have a closer look by understanding the involvement of any arthritis or fractures that may be present, we may refer you for medical imaging to give us the complete picture and enable us to create a thorough and well-informed treatment plan.

Sinus Tarsi Treatment

Home treatment

Before you get in to see your podiatrist, you can start easing your outer ankle pain and beginning your path to healing and repair at home by:

• Applying ice to the ankle up to four times per day. Wrap the ice in a towel, cloth or other protective material so that it’s not applied directly to the skin, and use it for no more than 15 minutes at a time. This should help reduce your inflammation, and hence your pain levels. You can also keep your ankle elevated to help promote swelling reduction.
  
• Strapping your ankle or using a compression bandage or sleeve to offer your ankle greater stability and support. If you’re unsure about the best ankle strapping techniques, we can guide you through these step-by-step during your appointment with us.
  
• Wearing good, supportive footwear both inside and outside of the house so your ankles are maximally supported. Consider good running or walking shoes (or cross-trainers) with a strong heel counter that holds your ankle in place well, and limits unwanted side-to-side movement. Avoid any light or barefoot sneakers (as they generally won’t offer the required level of support) as well as any shoes that are open-backed and therefore don’t work to control the ankle.
  
• Using non-steroidal anti-inflammatories (NSAIDs) as needed to help relieve pain and swelling. Use as instructed by your doctor.
  
• Avoiding physical activity that aggravates and worsens your symptoms - this not only causes pain but can worsen the problem, creating more inflammation and potential injury.
  

Podiatry Treatment

Your treatment and management plan with our Brisbane podiatrists is developed uniquely following a comprehensive assessment. This biomechanical assessment allows your podiatrist to understand the way that your ankles, feet and legs all move and work together, and all of the factors that are playing a role in overloading the outer ankle and placing excess pressure around the region of the sinus tarsi. We’ll then create a tailored treatment plan based on your results, that focuses on helping to heal and repair your existing injury, while keeping the ankle best supported going forwards so that you do not have to keep putting up with the pain in the future. 

If your sinus tarsi syndrome is linked to ankle instability or an ankle sprain, we will also put the right measures in place to help prevent recurrent ankle sprains. Your treatment may involve:

• Bracing your ankle using the innovative EXO-L anti-sprain brace, which is proven to prevent the majority of ankle sprains (and therefore damage to the sinus tarsi). 
  
• Custom foot orthotics: using custom-prescribed foot orthotics that sit inside your shoe can help provide some much needed stability and support for your ankle and the sinus tarsi. Your podiatrist will prescribe the best features for your orthotics based on the results of your biomechanical assessment. This means they may have helpful additions like higher later (outer) raised sides to significantly reduce any outwards ankle rolling, keeping your ankle situated in a much better position for supporting the sinus tarsi. 
  
• Foot mobilisation therapy: this is a hands-on treatment performed by your podiatrist that can help free up the joints in your feet to move without restriction, and therefore ease the potential strain on the area of the sinus tarsi.
  
• MLS laser: the MLS laser is a fantastic device that gives our patients with sinus tarsi syndrome a range of benefits - from pain relief and the reduction of inflammation to supporting healing and repair, and improving circulation in the area.
  

• 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.
  
• Physical therapy: 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. If you do not respond appropriately to the above treatment measures, cortisone injections may be useful 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. 

Preventing Sinus Tarsi Syndrome

While it’s not always possible to completely prevent sinus tarsi syndrome, there are several steps you can take to help reduce your risk. One of these steps is being mindful of the shoes you wear, choosing footwear that provides adequate support, stability, and cushioning for the feet and ankles. Choosing shoes with proper arch support and shock-absorbing properties can help distribute forces evenly and reduce the strain on the sinus tarsi during weight-bearing activities. 

Additionally, avoiding high-impact activities on uneven surfaces and gradually increasing the intensity and duration of physical activity can help prevent overuse injuries and minimise the risk of developing sinus tarsi syndrome. Incorporating regular stretching and strengthening exercises for the feet and legs, particularly the ankle and foot muscles, can improve flexibility, stability, and proprioception, reducing the likelihood of injury. 

Finally, if you have orthotics, it’s a good idea to wear them as much as possible, particularly during exercise and when you’re being active on your feet.

FAQs

Can sinus tarsi syndrome affect both ankles simultaneously?

Yes, sinus tarsi syndrome can affect both ankles simultaneously, although it most often occurs on the one side. Bilateral sinus tarsi syndrome may result from systemic factors such as biomechanical abnormalities, overuse injuries, or anatomical variations that affect both feet and ankles.

Is sinus tarsi syndrome more common in athletes or non-athletes?

Sinus tarsi syndrome tends to be more commonly associated with athletes who participate in sports involving repetitive impact or high-intensity activities, such as running, jumping, or court sports. With that said, we do see and treat plenty of non-athletes with sinus tarsi syndrome - their cause just tends to be different, such as from work-related factors (like repetitive movements at work), lifestyle factors, or underlying foot and ankle conditions or structure.

Can sinus tarsi syndrome lead to long-term complications or chronic ankle issues?

Yes, unfortunately in some cases, untreated or recurrent sinus tarsi syndrome may result in chronic ankle instability or weakness. This can lead to persistent pain, joint stiffness or weakness, and decreased mobility in the affected ankle, all of which have the potential to affect a person’s daily activities and quality of life. 

Are there any specific sports or activities to avoid if diagnosed with sinus tarsi syndrome?

Avoid high-impact activities that exacerbate pain or instability in the ankle, such as running on uneven surfaces, jumping, or participating in activities that require rapid changes in direction. Low-impact activities such as swimming or cycling may be more suitable alternatives during the recovery period. Our rule is that if it causes you pain or worsens your symptoms, put a hold on it for now.

Can sinus tarsi syndrome recur after successful treatment?

Yes, sinus tarsi syndrome may recur in some cases, particularly if the causative factors such as biomechanical abnormalities, structural issues, or inadequate rehabilitation are not addressed. This is why a big part of our treatment and management plan for you is understanding why your sinus tarsi syndrome has developed, addressing these causes, and putting the right measures in place to help minimise the likelihood of it recurring in the future.