Sinus Tarsi Syndrome

Sinus Tarsi Syndrome is a condition of the foot that causes pain and instability in the sinus tarsi region, the area of the foot between the heel bone and the ankle bone. The area of the foot is aggravated by various causes including ankle sprains, overuse, and trauma to the foot or ankle, and can make walking and physical activities difficult and painful.

In the past it has been reported that Ankle Sprains can cause Sinus Tarsi Syndrome. Ankle Sprains occur when the ligaments in the ankle are stretched or even torn. When this happens there is a likelihood that further problems could develop, including the development of Sinus Tarsi Syndrome. Often a serious trauma to the ankle or foot, including a fracture, will also be the cause of a patient’s symptoms of Sinus Tarsi Syndrome. Other causes of STS include Overuse Injuries where an over time the demands on the foot have been excessive for the foot’s structures to cope with, e.g. running and jumping athletes. The constant stress placed on the joints and structures of their feet results in the onset of STS.

The underlying pathology of Sinus Tarsi Syndrome is mainly due to local inflammation of the ligamentous tissue around the sinus tarsi. Typically this inflammation occurs as a direct result of injury to the ankle. Swelling and pain can develop, and the weakened ligament may become strained or even torn. Over time, chronic pain can develop from the repetitive stress on weakened foot structures. This is a common occurrence in individuals with chronic foot pain that has developed over time due to repetitive stress or overuse.

Although only few clinical cases of STS have been described in detail so far, the overall spectrum of symptoms correspond to that of other disorders affecting the lateral column of the foot. In particular, persistent pain on the outside of the foot, local swelling, or even marked foot edema, as well as difficulties while walking or even standing for long periods of time, are the typical complaints reported by affected individuals. Indeed, several patients suffering from STS have experienced a sensation of ankle instability, and may thus complain of difficulties while performing physical activities.

The pathology of Sinus Tarsi Syndrome typically involves inflammation and damage of the ligament around the sinus tarsi. As the foot undergoes movement, the damaged ligament becomes irritated further resulting in pain. Typically the pain experienced is in the outside of the ankle or foot. The pain in the lateral part of the foot and/or ankle can be sharp and or dull. In some cases weight bearing can be painful. This could be pain while walking, running, jumping, etc. The area of the foot and/or ankle can also become red, swollen, increased temperature to the area and sore to the touch. Some individuals report that they have difficulty standing for periods of time. Others report feeling as though their foot and/or ankle are unstable while walking or performing activities (Helgeson, 2009).

Diagnosis of sinus tarsi syndrome can be difficult and often involves the doctor or health care provider taking a medical history and performing a physical examination to assess for localized tenderness, swelling and restriction of movement. Further assessment of the foot may involve the use of imaging to obtain further information on structures inside the foot. This can be done using magnetic resonance imaging (MRI) to assess soft tissues such as ligaments) or arthroscopy (a minimally invasive surgical procedure where a small camera is introduced into the joint to assess for causes of pain and swelling) (Lee et al., 2008; Li et al., 2018).

As you can imagine, experiencing lateral foot pain can greatly affect a person’s way of life and mobility. Often Sinus Tarsi Syndrome causes people to avoid activities and can lead to decreased physical fitness and even weight gain in extreme cases. Many people even have to use mobility aids, such as crutches or braces, while they have symptoms of STS. The pain can also greatly affect a person’s sleep. When they do fall asleep, they can feel tired during the day as a result. In many cases, even simple movements can be very painful for people with STS, such as standing up from a seated position or even after just sitting for a short period of time or climbing up and down stairs. The good news is that with the right treatment, most people are able to return to their normal activities without feeling of pain and greatly improve their overall quality of life.

The various treatments for Sinus Tarsi Syndrome are geared towards relieving the symptoms of pain, limiting mobility, and improving the overall quality of life of a person who has been diagnosed with the condition. The degree of treatment required by a specific individual can vary depending on the degree to which he or she has been affected by the various symptoms and complications of STS. As with most conditions that cause significant pain and limited mobility, an individual suffering from the affects of STS may initially attempt to treat the condition using conservative methods of treatment. Typically, the most common method of conservative treatment for individuals with sinus tarsi syndrome is physical therapy. Individuals with sinus tarsi syndrome can also receive benefit from various forms of orthotics that can help to redistribute forces on the foot and alleviate pressure on the sinus tarsi. Oral anti-inflammatory medications such as ibuprofen, naproxen, or other similar drugs are also commonly prescribed for individuals suffering from symptoms of sinus tarsi syndrome. The oral anti-inflammatory pain medications are designed to help alleviate and control both pain and inflammation. In addition, it is also very important for individuals with sinus tarsi syndrome to participate in physical therapy exercises in order to help stimulate and aid in the healing of the weakened ligamentous structures that exist around the sinus tarsi. Many patients with sinus tarsi syndrome can receive satisfactory amounts of pain relief and improved mobility by undergoing treatment using the above-mentioned methods of both physical therapy and oral anti-inflammatory pain medications. However, there are some cases in which individuals with sinus tarsi syndrome are not able to receive the amounts of pain relief that they desire while undergoing treatment using the conservative methods of treatment for sinus tarsi syndrome. In such cases, individuals with sinus tarsi syndrome are typically recommended to undergo arthroscopic surgical treatment of the affected sinus tarsi. Arthroscopic treatment of the sinus tarsi is typically used as a last resort for the treatment of individuals with sinus tarsi syndrome. Arthroscopic surgery is a minimally invasive surgical procedure that allows a trained and experienced surgeon to visualize the interior of a joint using a small flexible tube that contains a camera and various other surgical instruments. The use of arthroscopic surgery has proven to be very effective for treating individuals with sinus tarsi syndrome. Studies that have been conducted to evaluate the effectiveness of arthroscopic surgery for the treatment of individuals with sinus tarsi syndrome have reported that a large percentage of individuals who have undergone arthroscopic surgery for sinus tarsi syndrome have reported having significant amounts of pain relief after undergoing the procedure. Therefore, arthroscopic surgery is a very effective treatment option for individuals with sinus tarsi syndrome who are not receiving the adequate amounts of pain relief after undergoing treatment using the above-mentioned methods of conservative treatment for sinus tarsi syndrome.

The most common non-surgical approaches to treating Sinus Tarsi Syndrome involve conservative methods of treatment. In many cases the use of physical therapy can aid in alleviating the symptoms of STS. Under the guidance of a physical therapist a variety of different exercises can be implemented that are designed to stretch and strengthen the muscles of the foot and ankle. Strengthening the muscles in this area can help to provide support to the sinus tarsi, and also to improve flexibility allowing patients to return to normal activities without pain. The use of physical therapy can be very beneficial in aiding individuals with STS to return to normal function and to complete activities of daily living without pain. Some individuals with STS can also benefit from the use of orthotics. Orthotics are shoe inserts which can be custom made to fit the foot of the individual and provide support to areas of the foot which are needed. In some cases the orthotics can be filled with a variety of different materials in order to provide additional support to specific areas of the foot.

In addition, there are various oral medications which can be prescribed for pain relief as well as to reduce inflammation. One of the most common types of oral medication prescribed is a non-steroidal anti-inflammatory drug (NSAID) which can give short-term relief of pain. While conservative treatment is usually very effective in treating STS, there are occasions when more aggressive treatment is required.

For individuals who do not improve with conservative treatment options, more aggressive forms of treatment are available. The primary form of treatment available is arthroscopic surgery. Arthroscopy is a minimally invasive surgical procedure that allows a doctor to look inside a joint through a small camera. Typically, several small incisions are made in order to insert the arthroscope as well as any necessary instruments. The sinus tarsi is a non-arthroscopically accessible area. Therefore, a separate incision is required to access the sinus tarsi. This incision is generally made on the outside of the ankle. The arthroscopic surgery can be used to remove inflamed tissue and/or debris from within the sinus tarsi (Schepers, 2011). A large amount of data has been compiled that supports the finding that a large percentage of patients that have received arthroscopic surgery for pain in the sinus tarsi have reported significant pain relief and have returned to full function (Li et al., 2018). Patients that have received arthroscopic surgery are also generally able to return to exercises and recreational activities, including sports.

These strategies are crucial to evaluating the effectiveness of certain STS treatments. Patients who undergo physical therapy for the sinus tarsi syndrome can expect to regain function in order to return to work and resume daily activities such as running, exercise, and play with family and children. Even more significant results have been reported from surgical interventions of the sinus tarsi syndrome with many patients having returned to normal function with decreased pain from postoperative period. The ability to exercise regularly, return to recreational activities, and have pain-free, long hours of work can have a profoundly positive impact on an individual’s physical health and mental well-being.

Finally, it is worth noting that timely and effective treatment of STS can allow a person to return to normal activities quickly and thus regain quality of life. Pain that is well managed, allows for normal social, work and family activities. Also, activities that require movement can have very positive effects on a person’s emotional well being and can counteract feelings of frustration and sadness that are felt by many people with chronic pain.

The variety of options for the treatment of Sinus Tarsi Syndrome is aimed at the alleviation of pain and the rehabilitation of individuals suffering with the condition. Both non-surgical and surgical approaches can be effective in the relief of symptoms and allow individuals to regain functional independence. Studies have shown that a variety of non-surgical approaches, including physical therapy, have been used to treat individuals with STS with good results (Yang et al., 2021). Furthermore, studies have shown that surgical approaches to the treatment of STS have provided very good results for individuals with chronic pain due to injury or overuse, with pain relief and return to function reported in the majority of cases (Schepers, 2011; Lee et al., 2008).

Citations:

Arshad, Z. and Bhatia, M., 2021. Current concepts in sinus tarsi syndrome: a scoping review. Foot and Ankle Surgery, 27(6), pp.615-621. https://www.sciencedirect.com/science/article/pii/S1268773120301831

Willegger, M., Bouchard, M., Schwarz, G.M., Hirtler, L. and Veljkovic, A., 2023. The evolution of sinus tarsi syndrome—what is the underlying pathology?—a critical review. Journal of Clinical Medicine, 12(21), p.6878. https://www.mdpi.com/2077-0383/12/21/6878

Khan, I., Peters, J., Welck, M. and Saifuddin, A., 2023. Sinus tarsi and sinus tarsi syndrome: an imaging review. European Journal of Radiology, 161, p.110725. https://www.sciencedirect.com/science/article/pii/S0720048X23000396

Helgeson, K., 2009. Examination and intervention for sinus tarsi syndrome. North American journal of sports physical therapy: NAJSPT, 4(1), p.29. https://pmc.ncbi.nlm.nih.gov/articles/PMC2953318/

Yang, C., Huang, Q., Cao, Y., Li, X., Zhu, Y. and Xu, X., 2021. Staged surgical management of sinus tarsi syndrome: our experience of 273 cases. Annals of Palliative Medicine, 10(8), pp.8909918-8908918. https://apm.amegroups.org/article/view/77249/html

Schepers, T., 2011. The sinus tarsi approach in displaced intra-articular calcaneal fractures: a systematic review. International orthopaedics, 35(5), pp.697-703. https://link.springer.com/article/10.1007/s00264-011-1223-9

Antoniadis, G. and Scheglmann, K., 2008. Posterior tarsal tunnel syndrome: diagnosis and treatment. Deutsches Ärzteblatt International, 105(45), p.776. https://pmc.ncbi.nlm.nih.gov/articles/PMC2697008/

Li, S.K., Song, Y.J., Li, H., Wei, B., Hua, Y.H. and Li, H.Y., 2018. Arthroscopic treatment combined with the ankle stabilization procedure is effective for sinus tarsi syndrome in patients with chronic ankle instability. Knee Surgery, Sports Traumatology, Arthroscopy, 26(10), pp.3135-3139. https://link.springer.com/article/10.1007/s00167-017-4813-2

Lee, K.B., Bai, L.B., Park, J.G., Song, E.K. and Lee, J.J., 2008. Efficacy of MRI versus arthroscopy for evaluation of sinus tarsi syndrome. Foot & ankle international, 29(11), pp.1111-1116. https://journals.sagepub.com/doi/abs/10.3113/fai.2008.1111

Lee, K.B., Bai, L.B., Song, E.K., Jung, S.T. and Kong, I.K., 2008. Subtalar arthroscopy for sinus Tarsi syndrome: arthroscopic findings and clinical outcomes of 33 consecutive cases. Arthroscopy, 24(10), pp.1130-1134. https://arthroscopyjournals.onlinelibrary.wiley.com/doi/abs/10.1016/j.arthro.2008.05.007