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  • Writer's pictureRobin R Varghese, PT.

"Sinus Tarsi Syndrome". Worried of the pain in the front and outer side of the ankle since injury?

Updated: Apr 10, 2023



What is Sinus Tarsi Syndrome?

  • Sinus tarsi syndrome (STS) is a clinical entity characterized by persistent anterolateral ankle pain secondary to traumatic injuries to the ankle.

  • Sinus tarsi syndrome is a condition of the ankle and foot that results from instability of the subtalar joint.

  • Athletes with this condition typically have complaints of instability with functional activities and persistent anterolateral ankle discomfort.

Subtalar joint and instability


  • The subtalar joint is comprised of the articulation of the talus and calcaneus across an anterior, middle, and posterior facet.

  • These facets may have variations in their structure and alignments.

  • These changes can affect the movement and stability of the subtalar joint.

  • Static stability of the subtalar joints is maintained by the intrinsic and the extrinsic ligaments.

  • Ruptures of the intrinsic ligaments allow increased movement of the subtalar joint that may result in instability.

  • Supination motions of the subtalar joint create a bony stability through the rearfoot and midfoot that is important for propulsive movements through the foot.

  • Pronation motions create increased mobility of the rearfoot and midfoot joints allowing the foot to accommodate to uneven surfaces.

What is Sinus Tarsi?

  • The sinus tarsi is a tube or tunnel between the talus and the calcaneus bones.

  • The sinus tarsi space is filled with many connective tissues that contribute to the stability and the overall proprioception of the ankle.

  • The space is filled with adipose tissue that serves as a bedding for numerous mechanoreceptors and free nerve endings, which along with the ligaments and muscles provide proprioceptive information on the movement of the foot and ankle.

  • Any pain or injury in this space causes Sinus Tarsi Syndrome or STS.


Causes

  • Single traumatic event or a series of ankle sprains

  • Overuse as in repetitive standing or walkingIinstability of the subtalar joint

  • Increased forces n the subtalar joint

  • Excessive movement of the subtalar joint

  • Occur as a compression injury, as with people who have flat or pronated feet. Here, talus and Calcaneus are pressed together as a result of the deformation. This causes bone to bone contact of the talus and calcaneus, with inflammation or arthritis in the sinus.


So what does it lead to?


As a result, there will be subtalar joint synovitis, chronic inflammation and infiltration of fibrotic tissues in the sinus tarsi which leads to anterolateral ankle pain.


Interventions?


Conservative and surgical interventions.


Surgery includes arthroscopic surgery, synovectomy, reconstructive procedures, reconstruction with arthrodesis, etc. followed by 6 weeks of immobilization.


Conservative intervention includes:


  • Nonsteroidal anti-inflammatory drugs to control synovitis and inflammation of connective tissues

Physical therapy

  • Immobilization by a brace or tape in the acute phase if associated with ankle sprains

  • Full range AROM exercises and mobilizations without provoking pain must be done in the recovery phase.

  • To diminish inflammation and pain and to influence the tissues in the sinus tarsi, friction massages, electrotherapy, laser-therapy, cryotherapy and other types of deep massages are effective.

  • There are no random control trials to show the efficacy of rehab programme for STS.


Cryotherapies, especially the use of ice massage over the lateral ankle, may also be useful for diminishing local inflammation and pain associated with this condition.


Stretching can reduce muscular stiffness of the gastrocnemius, posterior tibialis, or peroneal muscles found in athletes. Your physical therapist will be careful enough to avoid excessive forces across the subtalar joint as this may bring unexpected results.


Taping or strapping has also been used to specifically limit movements of the subtalar joint and the midfoot

-Subtalar sling helps to control movements at the talocrural and subtalar joints.

-Calcaneal sling is intended to provide support to the medial longitudinal arch of the foot.

Taping techniques have been used as a precursor for the use and selection of specific types of shoes and foot orthotics.


Specific joint mobilization techniques under precaution not to increase stress on the subtalar joints can address the limited joint mobility at the talocrural and mid tarsal joints.



Stability of the muscles that cross the subtalar joint can be improved by increasing their strength, endurance and proprioception.

This includes both static as well as dynamic stability.

The lack of proprioceptive information from the stabilizing ligaments of the joint must be compensated by the proprioceptive information from the muscle spindles and Golgi tendon organs of these muscles.


The three phases to attain joint stability are: Attain, Maintain, and Sustain.


The Attain phase will determine postures or positions the athlete is able to attain in a stable fashion.

The Maintain phase will develop coordinated isometric and eccentric muscle contractions of the muscles crossing the joint.

The Sustain phase will involve integrating all of the neuromuscular subsystems needed for stability during sports specific activities



Orthoses

  • Foot orthosis have been recommended as a method for limiting motion, though they might not provide the required stability at the subtalar joint during athletic activities.

  • They can reduce symptoms associated with STS.

  • The types of shoes the athlete is using for training, practices, and competition should also be considered, as well- constructed shoes can restrict excessive rearfoot movements.


At Valley Healing Hands, Brownsville, Texas we provide the best physical therapy for Sinus Tarsi Syndrome or STS. We have highly skilled physical therapists who will assess you and plan a customized programme as per your need. Our patients are more than satisfied with our services. You may learn about what they have to say by clicking here and get connected to us here. Our patients love us and you Too will!!!


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