Understanding Sinus Tarsi Syndrome

Sinus Tarsi Syndrome is a rather common foot injury for stop-and-go type sports, which can leads to pain in the sinus tarsi region of the foot.  Some refer to this area in front and slightly below the lateral malleolus as “the eye of the foot”. The sinus tarsus is a bony canal located on the outer (lateral) surface of the foot between the talus bone and midfoot.

The sinus tarsus contains the talo-calcaneal ligament, which spans between the talus and clacaneus bones. Injury to this ligament is commonly a result of an inversion mechanism, as with a lateral ankle sprain.

In 1957, Denis O’Connor was the first to use the term “sinus tarsi syndrome” to describe an injury which is characterized by pain, limitation of movement and instability in the hind portion of the foot. At the time, O’Connor treated the injury with a local injection of anesthetic agents into the sinus tarsus.

Common causes of sinus tarsus are inversion ankle sprains, chronic ligament instability and poor foot biomechanics.

The diagnosing of this injury is typically based on the mechanism of injury, the location of the symptoms, palpation findings in this area and the MRI findings.

Signs & Symptoms of Sinus Tarsi Syndrome

  • Pain just anterior to the lateral malleolus, which is the bony prominence on the outer border of the ankle. Prolonged standing usually aggravates the pain.
  • Point tenderness anterior to the lateral malleolus, which is typically aggravated by excessive ankle inversion and/or excessive eversion of the forefoot.
  • Instability and looseness of the lateral ankle and/or midfoot joints.

Professional Treatment for Sinus Tarsi Syndrome

  • Immediately ice the entire ankle and forefoot to help reduce inflammation and control pain.  Ice bags are good but an ice bucket is much better.
  • Mild anti-inflammatory medicines are sometimes prescribed by the treating physician to minimize the pain.
  • Immobilization of the ankle joint, the sub-talar joint and forefoot is a key early step to promote healing. This is best accomplished with a walking boot or a removable splint.
  • Utilize the latest physical therapy modalities and rehab devices to reduce swelling and decrease pain.
  • Assess and correct biomechanical problems related to the entire lower extremities if necessary with orthotics and postings.
  • Utilize a physical therapist to assist you with range of motion, manual strengthening and proprioceptive strengthening ankle exercises with tools such as a wobbles board.
  • Surgery is quite unusual and should only be considered for sinus tarsi syndrome cases that fail to respond to all other conservative forms of treatment.

Asking the Right Questions like a Pro

Here’s what a smart pro athlete would ask his/her sports medicine specialists to ensure a fast and safe return to sports:

  1. Have I developed sinus tarsi syndrome and what structures have been injured?
  2. Do I need to have an MRI or any other special test to confirm this diagnosis?
  3. Do I have any biomechanical concerns or previous injuries contributing to this injury?
  4. Will I need orthotics and if so, where can I have them made correctly with free adjustments for less than $300?

Elite Sports Medicine Tips from Mike Ryan

  • Bottom Line – The bottom line of your standing body is your foot.  Gravity is going to bring fluids to that foot.  Early and aggressive ice therapy and elevation is key.
  • Contol Your Weight – Rest is needed.  If the doctor gives you crutches, use them.
  • Proper Footwear – Check with the people that know and make sure you are wearing the proper shoes with the right fit for your sport.
  • Trust the Experts – If this is a chronic issue, the reasons can be many.  Take the time with the best physical therapist or certified athletic trainer available to learn from the best how to put this injury in the rearview mirror.