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Sinus Tarsi Syndrome

Discussion in 'Biomechanics, Sports and Foot orthoses' started by Kim, Oct 7, 2004.

  1. Kim

    Kim Member

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    Just trying to figure out the actual prevalence of Sinus Tarsi Syndrome. All that I have found so far refers to the origin of Sinus Tarsi Syndrome - being as a result of a previous inversion ankle sprain or vascular engorgement, nerve irritation.
    There has been talk that Sinus Tarsi Syndrome does not exist that it just another fallacy. However, I don't believe this to be true.
    Any ideas re: prevalence or existence?
  2. Cameron

    Cameron Well-Known Member

  3. podrick

    podrick Active Member

    sinus tarsi syndrome is not a fallacy and is not just common aftert inversion sprains of the ankle.it is mostly as a result of one's foot type,predominantly cavus foot types or patients with excessive rearfoot pronation.another incidence of sinus tarsi syndrome is seen as a result of systemic degenerative diseases such as reiters,rheumatoid etc.
    the actual pathology is seen as an inflamatory engorgement of the sinus tarsi whereby its neurovascular bundle becomes entraped.
    symptomology ranges from a burning or electric pain radiating from the lateral aspect of the foot and plantarly.diagnosis can be achieved via a lidocaine injection directly into the tarsi.if relief is attained then one can consider the possibility of sinus tarsi syndrome as a diagnosis.
    treatment however is another story.i have been very frustrated with treatment outcomes,particularly in the rigid foot.if anyone has any suggestions i am all ears.

  4. Kim

    Kim Member

    Thanks Rick,

    Glad to have another opinion. I was beginning to question the existence of Sinus Tarsi Syndrome as an indvidual complaint.
    As you said the diagnosis of Sinus Tarsi Syndrome is attained by injection of local anaesthetic into the tarsi; however, it is logical to assume that no matter the condition injection of an anaesthetic directly into the site of pain is going to eliminate said pain.
    Assuming that a diagnosis of Sinus Tarsi Syndrome has been made based on injection of L.A how many cases would you actually see? Just trying to gauge how common the condition actually is.

  5. andy

    andy Member


    It is imperative to make sure that your injection is in the sinus tarsi and not for instance over the anterior talofibular ligament. I often use fluoroscopy with contast just to make sure i am in the sinus tarsi. If in doubt over diagnosis then i tend to MRI.


  6. podrick

    podrick Active Member

    sinus tarsi syndrome diagnosis

    hi kim,
    any diagnosis we make must always corroberated by the patient's history and other clinical evaluations,of which the injection is one.however,we only do this after we have a remarkable history.
    i also agree with andy,flouroscopy can be very useful when attempting this type of injection.if one is available.but it is not a necessity.i also agree with andy that an mri is very useful in diagnosing sinus tarsi syndrome.howver,it must be read by a radiologist with musculoskeletal expertise and once again after both pertinent clinical findings.
    unfortunately,in today's medical market place it is very difficult to get insurance plans to pay for mri's,it is just a fact.
    the prevalence of sinus tarsi,at least in my practice is not to common.however,this depends on your patient population.if anyone has any literature findings with regards to its prevalence i would be interested.

  7. andy

    andy Member

    Sinus Tarsi


    I also agree with Rick that a full clinical history is imperative with diagnosis. I probably see 5-10 cases of sinus tarsi syndrome per year. I do however MR a number of patients with antero-lateral ankle pain following ankle inversion injury. An MR arthrogram is helpful in identifying damage to the ligaments as well as possible osteo-chondral lesions. I also agree that a musculoskeletal radiologist is essential and i am fortunate to have them in my hospital.

    Andrew Williams
  8. Dear Colleagues:

    Sinus tarsi syndrome is a relatively common problem that tends to affect both patients with maximally pronated feet and in patients who have a history of inversion ankle sprains. I see it in approximately 30% of the patients I treat with posterior tibial dysfunction and also see it following inversion ankle sprains. It is probably a condition with multiple etiologies but I feel that it is mainly due to either increased intraosseous compression forces within the sinus tarsi due to increased magnitudes of subtalar joint pronation moment or due to painful scar tissue within the sinus tarsi that is being irritated (overcompressed) by STJ pronation motion.

    Injection into the sinus tarsi with cortisone and local anesthetic is easily done without fluoroscopy control as long as you know the anatomy of the sinus tarsi. In addition, I rarely perform MRI scan specifically for sinus tarsi syndrome other than to rule out some other cause of the pain that is not responding to normal mechanical therapies.

    ELLEN CHRISTOU Welcome New Poster

    Iam putting in my own point on the Sinus Tarsi Syndrome. In March 2001, I had a fall in a private car park, where I worked. I twisted my right ankle, for several months after that I had really bad ankle pain. Not thinking anything about it I continued working from 9.00 - 5.00pm. It was only one day that I couldn't take it anymore that I decided to do something about it. I went to my GP sent me to have some X-rays done, they soon discovered that I had something in the ankle region that couldn't ve explained, I was then sent of to specialist who knew nothing about the sydrome but was willing to do something. The specialist then sent onto someone who did know something about the Sinus Tarsi.

    I wasn't sleeping at nights, I would go to be feeling exhausted but still having this pain in my ankle I would only sleep for about 5 hours then I would be up at 1.00 or 2.00am pacing the house because I wasn't able to sleep. This would be happening every night.

    By then my pain was controlled with any pain killers and sleeping pills this then became an addiction. So I decided just to live with the pain, by then it was the middle of 2002. I was then referred to another specialist who had moved from Sydney - Australia to Canberra where I live. By then I was willing to do anything.

    My doctor suggested I have a steriod injection in my ankle this worked for about 6-10 weeks then I would be back in the same pain again. I was also seeing a podiatrist as well he also suggested with the steriod injection I have cortisone as well as the steriod injection. The pain would go for about 6-1o weeks then it wold be back again worse than ever. At that time I had put on alot of weight both from the steriod and cortisone injection, so my local GP and my podiatrist at that time suggested that I be referred to someone who was willing to bring down my weight and try and gt some strength into my ankle.

    In April 2003, I finally decided to have an operation that would try and fix this problem. I now have a 3 1.2 inch screw inserted into my ankle, I had a cast on my ankle for about 6 weeks and then another cast for about 10 weeks. All this time i was house bound and not able to do anything.

    To this day I still have some pain in my ankle. I certainly know when it is going to rain.

    To anyone who has Sinus Tarsi, good luck it's not something which is recognised.
  10. podrick

    podrick Active Member

    sinus tarsi syndrome?

    i read your case with great interest and i must say that based on the clinical history that you are presenting.i don't think you had sinus tarsi syndrome.you might have had a fracture of the actual ankle or sinus tarsi which might have been missed and later on contributed to the intercompartment pain in the sinus tarsi.
    sinus tarsi syndrome usually does well after injection therapy,immobilization and finally orthosis.the course of treatment that they followed with you is more indicative of either a fracture or possibly a ligamentous/muscular tear,which was missed earlier.
    either way i hope you improve and feel better.
  11. Atlas

    Atlas Well-Known Member

    Very strange that this 'pain' was (semi)relieved by pacing; almost as though some part of your foot didn't like rest/inactivity etc. Goes against the grain for most musculo-skeletal foot conditions.

    About Sinus Tarsi syndrome, isn't a nerve supposed to be compromised; which means there must be some neurological sensation or deficit more distal if it exists.

    OK injection may work, but the agent must influence multiple tissues; so how do we surely know?

    Sinus Tarsi syndrome is a typical example of the rare complicated pathology IMO. What frustrated me as a new graduate years ago, was that I would go to a seminar/conference hoping to be a better practitioner by Monday. But we would spend 95% of the time on a rare complicated presentation; rather than focusing on ways to do the common things uncommonly well. On the Monday I might have seen 4 ankle sprains, yet I was trying to find the sinus tarsi hidden in them :cool:

    ELLEN CHRISTOU Welcome New Poster

    Sorry I don't know what to say. I can only tell you what I was feeling at that time.
  13. cpoc103

    cpoc103 Active Member

    Further to Mr Kirby, I agree Sinus Tarsi syndrome is a relatively common condition, I work within the NHS in England and see this condition in about 20% of my case load. It is often misdiagnosed, can be seen quite often with a maximally pronated STJ, and in patients with inversion/recurrent inversion sprain. The pain, pt's get is most likely not attributable to just one structure involvement, as we are aware there are many structures which pass through the tunnel.
    MRI can indeed and has a valid place for diagnosing, however, is a costly tool. If STS is indeed present a simple injection of L.A into the correct area of the tunnel will aid in the diagnosis. There are arguments, would'nt L.A knock out almost all pain within the hind foot, NOT neccessarily, if the injection is in the correct place, then if the pain is coming from the tarsi it will dissipate, if there is still pain then it is most likely not STS. There is a lot of emerging literature on the use of ultra sound to aid in steroid injections, and this is another tool which can guide when injecting into the tunnel, and is no where near as expensive as MRI.

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