Sinus Tarsi Syndrome Expert Relief | Arunalaya Physiotherapy

Best Sinus Tarsi Syndrome Treatment In Delhi NCR.

What is Sinus Tarsi Syndrome ?

Sinus Tarsi Syndrome (STS) is a painful condition affecting the sinus tarsi, a small, cone-shaped tunnel or canal located on the outer side of the ankle, between the ankle bone (talus) and the heel bone (calcaneus). This space contains ligaments, nerves, blood vessels, and fatty tissue. When these structures become inflamed, irritated, or damaged, it leads to the characteristic pain and symptoms of Sinus Tarsi Syndrome.

Causes of Sinus Tarsi Syndrome

STS is primarily caused by:-

Ankle Sprains (Most Common): The vast majority of STS cases (70-80%) occur after an ankle sprain, particularly an inversion ankle sprain (where the foot rolls inward). This type of sprain can stretch or tear the ligaments within the sinus tarsi (such as the interosseous talocalcaneal ligament and cervical ligament), leading to inflammation, scar tissue formation, and instability in the subtalar joint (the joint below the ankle that allows side-to-side foot movement).
Foot Biomechanics/Overpronation (Flat Feet): In individuals with flat feet (pes planus) or excessive pronation (the foot rolls inward excessively when walking), the space within the sinus tarsi can be compressed. This chronic compression and impingement of the soft tissues and nerves within the sinus tarsi can lead to inflammation and pain.
Repetitive Stress/Overuse: Activities that involve repetitive twisting, turning, or excessive weight-bearing on the ankle can irritate the structures in the sinus tarsi. This is common in athletes or individuals with jobs requiring prolonged standing or walking on uneven surfaces.
Subtalar Joint Instability: Damage to the ligaments within the sinus tarsi can lead to instability of the subtalar joint, which then causes abnormal motion and irritation in the area.
Arthritis: Degenerative changes or inflammatory arthritis (like rheumatoid arthritis) in the subtalar joint can cause inflammation and pain in the sinus tarsi.
Other Less Common Causes: These can include synovial cysts, scar tissue formation from previous injuries, or rarely, tumors.

Symptoms of Sinus Tarsi Syndrome

Pain: Localized pain and tenderness on the outer (anterolateral) aspect of the ankle, specifically over the sinus tarsi region.
- The pain is often a constant, dull ache, but can become sharp or stabbing with certain movements or activities.
- Worsens with weight-bearing, walking, running, climbing stairs, or prolonged activity.
- Often aggravated by turning the foot inward (inversion) or outward (eversion).
- Pain is typically worse when walking on uneven surfaces (e.g., grass, gravel).
Swelling: May be present in the affected area, though it can be subtle.
Feeling of Instability: A sensation of the ankle “giving way” or feeling unstable, especially when walking on uneven ground or pivoting. This is particularly common if there’s underlying subtalar joint instability.
Limited Range of Motion: Pain may restrict the movement of the subtalar joint, particularly inversion and eversion.
Tenderness to Palpation: Direct pressure on the sinus tarsi will elicit pain.

Advanced Physiotherapy for Sinus Tarsi Syndrome

Advanced physiotherapy for STS aims to reduce pain and inflammation, restore subtalar joint stability and mobility, improve foot and ankle biomechanics, and facilitate a safe return to desired activities.

Acute/Pain Management Phase:
- Ice and Compression: To reduce pain and inflammation.
- Manual Therapy: Gentle soft tissue massage around the ankle to address muscle tightness (e.g., calf muscles) and reduce swelling.
- Gentle Mobilizations: Non-painful, low-grade joint mobilizations for the subtalar joint to maintain mobility without irritating the area.
- Pain-Free Isometrics: Gentle activation of ankle and foot muscles without movement to prevent atrophy.
Restoration of Mobility and Flexibility:
- Ankle and Foot Range of Motion: Exercises to restore full, pain-free range of motion in the ankle (dorsiflexion, plantarflexion) and subtalar joint (inversion, eversion).
- Calf Muscle Stretching: Essential to address any tightness in the gastrocnemius and soleus muscles, as calf tightness can impact ankle and foot biomechanics.
- Myofascial Release: More targeted techniques to release tight fascia and muscles in the lower leg and foot.
Subtalar Joint Stability and Strengthening:
- Intrinsic Foot Muscle Strengthening: Exercises to strengthen the small muscles within the foot, which are crucial for arch support and stability. Examples include “short foot” exercises and toe curls.
- Ankle Stabilizer Strengthening: Concentric and eccentric strengthening of muscles that control the ankle and subtalar joint, particularly the peroneal muscles (eversion) and tibialis posterior (inversion/arch support). This uses resistance bands, weight training, and bodyweight exercises.
- Proprioception and Balance Training: Crucial for regaining stability, especially after an ankle sprain. This progresses from stable surfaces to unstable surfaces:
  - Single-leg standing (eyes open, then closed).
  - Balance boards, foam pads, BOSU ball.
  - Dynamic balance exercises (e.g., reaching, throwing a ball while balancing).
  - Walking on uneven surfaces (controlled environment)
- Neuromuscular Control Drills: Exercises to improve the coordination and rapid firing of muscles around the ankle, especially important for reactive stability.
Biomechanical Correction and Functional Integration:
- Gait Analysis: Assessment of walking and running patterns to identify any abnormal foot mechanics (e.g., excessive pronation) that contribute to STS.
- Lower Limb Kinetic Chain Assessment: Evaluating the entire lower limb (hip, knee, core) for any weaknesses or imbalances that might be affecting ankle mechanics. Strengthening exercises for these areas may be incorporated.
- Sport-Specific Rehabilitation (for athletes): Gradually reintroducing sport-specific movements, cutting, pivoting, jumping, and landing drills with a focus on proper technique to ensure the ankle can withstand the demands of the sport.
- Plyometric Training: For higher-level athletes, once sufficient strength and stability are achieved, plyometrics can improve power and explosiveness while enhancing dynamic stability.

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