What is Sinus Tarsi Syndrome ?
The sinus tarsi is a small bony tube which inserts into the ankle beneath the talus bone. The sinus tarsi can be injured or damaged due to overuse along with over pronation or bad foot biomechanics.
Causes of Sinus Tarsi Syndrome
Individuals who have had a history of inversion ankle sprain are more prone to injure the sinus tarsi. The diagnosis is confirmed if an anesthetic injection given into the painful sinus tarsi results in relieving pain and restoring normal function.
Symptoms of Sinus Tarsi Syndrome
- Localized pain anterior to the lateral malleolus (bony part on the external side of the ankle).
- Weight bearing may cause a feeling of instability.
- The patient has difficulty walking on uneven surfaces such as gravel and grass.
- Tenderness is present on the external side of the ankle.
- Pain on the affected side of the ankle when running on a curve.
- The subtalar joint suffers from a passive inversion.
- Pain upon palpating the sinus tarsi region.
- Increasing pain upon foot inversion and eversion.
- The diagnosis is confirmed if an anesthetic injection given into the painful sinus tarsi results in relieving pain and restoring normal function.
- An MRI scan helps in showing any excessive fluid present in the sinus tarsi.
- Ankle arthroscopy helps in directly evaluating the sinus for any damaged or injured tissue.
Treatment of Sinus Tarsi Syndrome
- Rest should be taken from aggravating activities.
- Ice or cold therapy helps in reducing pain and inflammation.
- NSAID's or non steroidal anti inflammatory medicines such as ibuprofen help in relieving pain and inflammation. Asthmatic patients should not take these medicines.
- Electrotherapy such as ultrasound helps in reducing inflammation.
- The subtalar joint should be immobilized.
- Biomechanical problems should be resolved. Proper foot wear, ankle sleeves should be used.
- Strengthening exercises should be done for the ankle e.g. proprioception exercises with the use of a wobble board.
- The calf muscles should be stretched.
- Patient should undergo physical therapy and rehabilitation.
- Overpronation can be corrected with the help of orthotics.
- Severe cases may require oral steroids or steroid injections.
- Rarely surgery may be required.
Recovery Time For Sinus Tarsi Syndrome And Exercises For Recovery
Recovering from Sinus Tarsi Syndrome can be a tedious task. Once your injury has healed and after appropriate physical therapy most of the people can return to sports within six months although in some cases it may take up to nine months for complete recovery from Sinus Tarsi Syndrome. When it comes to minor cases of Sinus Tarsi Syndrome, it may take anywhere from four to six weeks for complete recovery and returning back to normal activities but it is essential to complete physical therapy and do it diligently to return back to normal activities without any hassles.
When it comes to exercises for Sinus Tarsi Syndrome, this should be done under the supervision of a physical therapist. This begins with stretching the ankle. Once you can stretch the ankle pain free then you may advance to strengthening exercises. It should be noted here that when doing stretching exercises apart from ankle stretching you should also concentrate on calf stretches as well for best outcomes. Below mentioned are some of the exercises for Sinus Tarsi Syndrome.
Ankle Up/Down Exercise for Sinus Tarsi Syndrome: To do this exercise, lie down on an exercise table and try and move the ankle up and down as far as possible without experiencing any pain and feeling only minimal stretch. Repeat this exercise about 20 times.
Ankle In/Out Exercise for Sinus Tarsi Syndrome: Lie down on an exercise table and move the ankle in and out as far as possible without having any pain and feeling just a mild stretch. Repeat this about 20 times provided it is pain free.
Ankle Circles: To do this exercise, lie on a table and move the foot and ankle in a circle as large as possible without having any pain and feeling on mild stretch. Repeat this about 20 times making sure the exercise is pain free.
Sitting Calf Stretch Exercise: To do this exercise, sit on the floor with the legs stretched straight in front. Place a towel around the ball of the foot and hold the two ends of the towel with the hands. Now, draw the toes and foot upwards and pull it with the towel so as to increase the flexion of the ankle until a strong stretch is felt in the back of the calf. Maintain this position for about 30 seconds and do it for about four times a day.
Seated Calf Stretch for Sinus Tarsi Syndrome: To do this exercise, sit in a chair with the legs stretched straight out in front. Just like the previous exercise, place a towel around the ball of the foot and hold the two ends of the towel. Now sit straight up and pull the toes and ankle upwards and pull through the towel increasing the stretch in the back of the calf. Maintain this position for about half a minute and do it about three times a day.
Standing Gastrocnemius Stretch: In this exercise, stand facing a wall and place the injured leg behind you making sure that the toes are pointing forwards. Standing straight with the knee kept straight move forwards on to the front leg until a stretch is felt in the calf muscle on the leg that is behind you. Maintain this position for about half a minute and do it three times a day.
Standing Soleus Stretch for Sinus Tarsi Syndrome: To do this exercise, stand straight facing a wall and place the injured leg behind you and ensuring that the toes are pointing forwards bend the back knee slightly and standing straight lean into the wall until a stretch is felt in the calf muscle on the leg that is behind. Maintain this position for about half a minute and do it for about three times.
Once you can stretch the calf and the ankles pain free then you can be advanced to strengthening exercises. Below mentioned are some of the strengthening exercises.
Foot Pumps: This form of exercise is quite simple to do and it also strengthens the calf muscles and facilitates improved circulation. To do this exercise, you need to lie on a bed with the legs straight in front of you. Now, point the toes downwards and away from you and pull the foot towards yourself as much as you can. Repeat this motion for about two minutes. In cases of doing this exercise postsurgery, then this needs to be done every two hours.
Seated Calf Raises: This form of exercise increases the flexibility and strength of the calf muscles. In order to do this exercise, you need to sit on a chair with feet flat on the floor and the knees bent perpendicularly. Now, slowly press the toes on the floor while trying to lift the heel up as high as you can. Maintain this position for about 15 seconds and come back to the starting position. This exercise needs to be done about 20 times a day.
Standing Calf Raises: This exercise is done by exercising the calf against gravity in order to strengthen them. To do this exercise, stand with the feet flat on the ground holding on to a wall for balance. Try and rise up on the tiptoes as high as you can. Maintain this position for about 10 seconds and slowly comes back to starting position. Do three sets of 10 per day.