Summary
- The sinus tarsi is a small tunnel which sits between the talus and calcaneus.
- Sinus tarsi syndrome is characterized by acute, localized pain in the lateral side of the foot below the ankle, and is caused by compression of the structures in the sinus tarsi.
- Symptoms are often exacerbated by standing and walking, and there may be an associated flatfoot deformity.
Diagnostic tips
- Presents with localised pain in the anterolateral ankle.
- Associated with ballet dancers, pronated foot type, sitting on feet.
- Symptoms are typically worse in the morning and may present as pain and stiffness that slowly improves as the patient warms up.
- Symptoms are often aggravated by standing or walking.
- A flatfoot may be a prominent feature of this condition.
Tests and Imaging
- Abducting and everting the foot may reproduce symptoms.
- Injection of local anaesthetic into the sinus tarsi which results in cessation of pain indicates a positive diagnosis.
- X-rays (weightbearing) may show some impingement in the sinus tarsi area. This also use to rule out other cause of pain.
- MRI often shows shows evidence increased blood flow (edema) in the involved bones (calcaneus, talus and fibula).
Immediate Treatment
- Activity modification to avoid activities that precipitate symptoms.
- Anti-inflammatory medications to improve pain and swelling.
- A local injection of corticosteroids may help settle symptoms in this area.
Possible Referral
- Podiatry for footwear advice, biomechanical assessment and appropriate anti-pronatoryorthoses.
- Foot and ankle surgeon for surgical treatment for patients that have truly failed non-operative treatments.
