Sinus Tarsi Syndrome

What is sinus tarsi syndrome?

Sinus tarsi syndrome is painful swelling on the lower outside part of your ankle. Specifically, it’s inflammation in the subtalar joint — where your ankle bone (talus) meets your heel bone (calcaneus).

The subtalar joint lets you tilt your foot from side to side. The sinus tarsi is the medical name for the small space between the talus and calcaneus. It’s like a tunnel road through a mountainside, but instead of making room in rock for cars, it’s a passageway in your bones that lets ligaments, nerves and blood vessels pass through it to reach other parts of your foot and ankle.

Sinus tarsi syndrome happens when something irritates the tissue in your sinus tarsi. The irritated tissue swells up, and that extra pressure in the small space causes pain. Ankle sprains are the most common cause, especially if you sprain the same ankle more than once.

Visit a healthcare provider or podiatrist if you’re experiencing pain and swelling in your ankle or heel that make it hard to move or use your foot and ankle.

Is tarsi sinus syndrome common?

Experts think sinus tarsi syndrome is rare. It’s hard to estimate because lots of people who have it may not get an official diagnosis. Also, it shares lots of symptoms with other, similar ankle issues.

What are sinus tarsi symptoms?

Ankle pain and swelling are the most common sinus tarsi syndrome symptoms. The pain and swelling will be worst on the outside lower edge of your ankle, but they might spread (radiate) to other areas of your ankle.

You’ll probably be able to see and feel the swelling in the space between your ankle and heel bones. The swelling is sometimes so noticeable that people think they have a lump like a cyst under their skin.

What does sinus tarsi syndrome feel like?

Sinus tarsi syndrome pain is usually a constant ache that feels sharper or stabbing when you move or use your foot, especially if you:

• Turn your foot toward or away from the center of your body.
• Put your weight on it to walk, run or climb stairs.
• Touch or press the area around your sinus tarsi.

What causes sinus tarsi syndrome?

Any injury or condition that damages your subtalar joint or sinus tarsi can cause sinus tarsi syndrome.

Ankle sprains are the most common cause. Around 80% of people with sinus tarsi syndrome sprained their ankle by rolling it to the outside, away from the center of their body. Slips, falls and sports injuries are all common ways people sprain their ankles.

Ankle injuries can also cause synovitis in your subtalar joint, and the swelling from that can lead to sinus tarsi syndrome.

The natural shape of your feet, the way you walk and certain health conditions can put extra stress on your sinus tarsi and cause sinus tarsi syndrome over time. Noninjury causes of sinus tarsi include:

• Having flat feet.
• Walking or running with overpronation.
• Foot and ankle arthritis.
• Obesity.

What are the risk factors?

Anyone can develop sinus tarsi, especially because ankle sprains are extremely common injuries. You might have an increased risk if you:

• Play a sport that makes you twist and suddenly change directions (like soccer, basketball or hockey).
• Do physical work or stand on hard surfaces often.
• Are pregnant. Pregnant people have an increased risk of overpronation.
• Sprain the same ankle more than once. Re-spraining an ankle you’ve injured in the past increases the chances you’ll develop sinus tarsi syndrome.

How do healthcare providers diagnose sinus tarsi syndrome?

A healthcare provider will diagnose sinus tarsi syndrome with a physical exam. They’ll examine your injured ankle, look for swelling and press (palpate) the sinus tarsi. They might ask you to stand, walk or move your ankle. Tell your provider if any touch, position or movement hurts or makes the pain worse.

Tell your provider when you first noticed symptoms, especially if you know exactly when the injury happened or what caused it.

Sinus tarsi syndrome causes the same kinds of symptoms as other ankle and foot conditions, including:

• Foot and ankle arthritis.
• Calcaneal stress fractures.
• Talus fractures.
• Tarsal tunnel syndrome.

Sinus tarsi tests

Your provider might use imaging tests to take pictures of your ankle and the area around it, including:

• Foot X-ray.
• MRI (magnetic resonance imaging).
• CT scan (computed tomography scan).

How do you fix sinus tarsi syndrome?

Your healthcare provider will suggest sinus tarsi treatments to reduce the swelling and pain in your sinus tarsi. The most common treatments include:

• Over-the-counter (OTC) pain relievers: Over-the-counter NSAIDs or acetaminophen reduces inflammation and relieves pain. Don’t take these medications for more than 10 days in a row without talking to your provider.
• Corticosteroids: Corticosteroids are prescription anti-inflammatory medications. Your provider might give you cortisone shots directly into your subtalar joint.
• Immobilization: You might need to wear an ankle brace or walking boot that holds your ankle still and keeps it supported while it heals. Your provider might suggest taping your ankle to add extra support. They’ll show you how to apply tape safely.
• Physical therapy: A physical therapist will show you stretches and exercises that strengthen the muscles around your ankle. They’ll help you regain your range of motion (how far you can move your ankle).
• Orthotics: Orthotics are shoe inserts that you can buy over the counter or have custom made. Your provider will tell you which kind you’ll need and how often to wear them. They might also suggest that you wear (or avoid) certain types of shoes to support your feet and ankles.
• Surgery: It’s rare to need surgery for sinus tarsi syndrome. Your provider might suggest it if other treatments don’t work and you’re still experiencing severe pain or swelling. They’ll tell you which type of surgery you’ll need and what to expect.

How can I prevent sinus tarsi syndrome?

There might not be any way to prevent sinus tarsi syndrome, especially if you’re an athlete. But there are ways you can lower your risk. During sports or other physical activities:

• Wear the proper protective equipment (including the right type of shoes or footwear).
• Don’t “play through the pain” if your ankle hurts during or after physical activity.
• Give your ankles time to rest and recover after intense activity.
• Stretch and warm up before playing sports or working out.
• Cool down and stretch after physical activity.

Follow these general safety tips to reduce your risk of an injury:

• Make sure your home and workspace are free from clutter that could trip you or others.
• Always use the proper tools or equipment at home to reach things. Never stand on chairs, tables or countertops.
• Use a cane or walker if you have difficulty walking or have an increased risk of falls.

Will sinus tarsi syndrome go away?

Sinus tarsi syndrome usually goes away once you find treatments that manage your symptoms. The pain will go away when the swelling in your sinus tarsi improves.

Sinus tarsi syndrome caused by an ankle sprain usually gets better gradually, as the sprain heals. It can take around a month for a sprained ankle to heal.

It might take longer to recover if something about the natural shape of your feet or a health condition causes sinus tarsi syndrome. Ask your healthcare provider or podiatrist what to expect.

When should I see my healthcare provider?

Visit a healthcare provider if you’ve experienced an injury and have sinus tarsi syndrome symptoms. Talk to your provider if your symptoms aren’t improving after a few days of treatment (or if they’re getting worse).

When should I go to the emergency room?

Go to the ER if you experience any of the following:

• Extreme pain.
• Swelling that’s getting worse.
• Discoloration.
• You can’t move your foot or ankle.

Which questions should I ask my healthcare provider?

Questions you may want to ask your provider include:

• Do I have sinus tarsi syndrome or another ankle issue?
• Is my ankle sprained? Is that what caused sinus tarsi syndrome?
• Will I need any tests?
• Which treatments do you suggest to manage the pain and swelling?
• How long should I avoid physical activities?

A note from Cleveland Clinic

The sinus tarsi is a tiny space in your ankle that can cause big-time pain if it’s irritated. Sinus tarsi syndrome happens when an injury or other issue causes swelling in that small area between your ankle and heel bones. Ankle sprains cause most cases of sinus tarsi syndrome.

Visit a healthcare provider or podiatrist if you’re experiencing ankle pain that’s making it hard to move or use your foot or ankle — especially if you know you slipped, fell or sprained it. They’ll help you get to the bottom of what’s causing your symptoms and explain what you can do to help your ankle heal. Sinus tarsi syndrome can be extremely uncomfortable, but it’s usually a temporary issue. You should be able to resume all your usual activities once your ankle heals and the swelling goes away.