Noninvasive treatment methods for sinus tarsi syndrome can often help improve symptoms and allow a full recovery. However, in some cases, surgery may be necessary to resolve symptoms.

Sinus tarsi syndrome describes when a person experiences discomfort in an area on the outside of their foot, typically due to an injury such as rolling their ankle. It can also occur if an individual has flat feet or fallen arches.

Initially, a healthcare professional will try noninvasive treatments such as medications and supportive devices to treat the condition. However, if these options do not work, a doctor may suggest surgery.

In this article, we will discuss the treatment options available for sinus tarsi syndrome.

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Sinus tarsi syndrome is when swelling and pain occur on the outside of the joint below the ankle. Healthcare professionals refer to this area between the ankle and heel bone as the sinus tarsi or tarsal sinus. Some may also refer to it as the eye of the foot. The joint in the area, known as the subtalar joint, is responsible for allowing the rotation of the foot.

The condition often occurs due to a traumatic event, such as an ankle sprain, but it can also occur due to repeated damage to the local ligaments. Most cases occur due to supination, which is when a person places their weight on the outside of the foot while walking or running. Conversely, it can also occur due to pronation, where a person rolls their foot inwards.

In some cases, sinus tarsi syndrome may occur due to flat feet, which can result in a person having either no arch in the foot or one that is very low. This puts extra pressure on the subtalar joint and can increase pressure on the soft tissue in the ankle area, resulting in inflammation.

Treatment for sinus tarsi syndrome often starts with nonsurgical or conservative options. Nonsurgical therapies often have a positive effect on the condition.

Some common nonsurgical treatments include:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs): Available as either over-the-counter or prescription medications, these drugs can help provide a combination of pain relief and inflammation reduction.
  • Supportive devices: These devices can help immobilize the joint, provide support for walking, and help prevent further injury to the joint. Supportive devices include braces, medical boots, or shoe inserts to support the arch. A doctor or physical therapist may recommend specific shoes to help provide better support to the arch, foot, and ankle.
  • Steroids: These drugs can help with inflammation, reducing pain and swelling of the joint. Steroids are available on prescription, and a person often administers them through an injection. This treatment may help if the condition does not respond to other methods.

A doctor may recommend surgical treatment options for a person with severe sinus tarsi syndrome or if symptoms do not improve with nonsurgical options.

Surgery options include:

  • Scar tissue removal: In some cases, a surgeon may consider removing scar tissue, typically using a minimally invasive technique known as arthroscopy.
  • Flatfoot surgery: A surgeon may use a combination of procedures to adjust the ligaments, bones, and tendons supporting the arch if the condition occurs due to flat feet.
  • Subtalar fusion: If discomfort occurs due to subtalar arthritis, also known as hindfoot arthritis, subtalar fusion may be necessary. This procedure fuses or locks the joints together. A doctor may use this option when they cannot replace the joint.

A person can review the surgical options with a surgeon or other doctor, who will explain the potential pros and cons of each procedure and provide recommendations based on the individual’s specific case.

It is also important to address any additional medical conditions that may be aggravating the condition, such as obesity or diabetes.

Recovery from sinus tarsi syndrome can often take several weeks when using conservative methods.

Individuals who undergo surgery will also typically require several weeks of recovery time. In some cases, it may take up to 3 months for them to return to sporting activities and 6–12 months to make a full recovery.

The type of surgery can affect recovery times. For example, flatfoot surgery requires that a person put no weight on the foot for at least 6–8 weeks after the procedure. They may be able to apply full weight within 10–12 weeks. After 12 weeks, a person can transition to using ordinary shoes, but they will likely need to immobilize the ankle and use assistive devices for walking and movement. Full recovery often takes 1–2 years.

Following subtalar fusion, a person can expect to wear a boot for about 8–12 weeks.

In all cases, a person should follow advice from a surgeon and physical therapist regarding how to care for the joint and foot and how and when to return to activities. Not following these recommendations can prolong recovery time and may lead to further or worsening injury.

There are also some risks of surgical complications, including infection, surgery failure, and pain.

Sinus tarsi syndrome often causes:

  • pain or discomfort on the outside of the foot, typically behind and under the ankle
  • swelling around the ankle and heel
  • instability and worsening symptoms when standing, walking, or putting pressure on the ankle

A person may want to contact a doctor if:

  • symptoms do not improve over time
  • NSAIDs and rest do not seem to help
  • the pain is severe and interferes with daily life or activities, such as sports, work, or school

A healthcare professional, such as a doctor specializing in orthopedics, will likely review the person’s symptoms and request imaging tests to determine the cause of the pain and rule out other possible causes, such as a cyst or tumor. If they diagnose sinus tarsi syndrome, they will recommend therapies to help the person recover.

Sinus tarsi syndrome typically causes pain and swelling below the ankle joint on the outside of the foot. It often occurs due to injury, such as spraining the ankle.

Initial treatment options include conservative approaches, such as NSAIDs, wearable supports, and injections. A doctor may recommend a surgical option if conservative treatments do not work. Surgeries may adjust a flat foot, remove damaged tissue, or fuse the joint.

Recovery often takes a few weeks, but surgery may increase the time a person requires before returning to their usual activities.