Have you ever had ankle pain that no scan seemed to fully explain, yet every step on uneven ground made you feel unstable and hesitant?

I still remember a recreational runner I worked with a few years ago who told me, “It feels like my ankle doesn’t trust me anymore.” His MRI looked almost normal, his X-rays were unremarkable, yet he avoided slopes, stairs, and even casual walks. The diagnosis that finally made sense of his symptoms was Sinus Tarsi Syndrome (STS)—a condition that is frequently overlooked, misunderstood, and often mismanaged.

Sinus Tarsi Syndrome may sound obscure, but for athletes, office workers, and anyone who has suffered repeated ankle sprains, it can be a silent source of persistent pain and instability. This article draws on clinical physiotherapy experience, current research, and expert-backed insights to explain why STS occurs and how physiotherapy offers one of the most effective long-term solutions. If you are dealing with unresolved ankle pain, this may be the missing piece of the puzzle.

What Is Sinus Tarsi Syndrome?

The sinus tarsi is a small, tunnel-like space on the outer side of the foot, located between the talus and calcaneus bones. Although compact, it plays a crucial role in foot stability, proprioception, and smooth ankle movement.

Sinus Tarsi Syndrome refers to pain, tenderness, and functional instability arising from inflammation or injury within this space. Patients often report deep ankle pain, a feeling of “giving way,” and discomfort that worsens on uneven surfaces.

From a clinical perspective, STS is less about a single structure and more about a failure of stability and sensory feedback in the subtalar joint.

According to Foot and Ankle Clinics, sinus tarsi pain is frequently associated with subtalar joint instability following ankle trauma, particularly inversion sprains.

Why Sinus Tarsi Syndrome Is Commonly Missed

One of the biggest frustrations for patients is that STS often escapes early diagnosis. The reasons are straightforward:

• Symptoms overlap with ankle sprains, plantar fasciitis, or peroneal tendinopathy
• Standard imaging may appear normal
• Pain is deep and poorly localised

A 2020 review in the Journal of Orthopaedic Research highlighted that STS is underdiagnosed due to clinicians focusing on larger ligament injuries while overlooking subtalar joint mechanics.

In practice, many patients only receive a diagnosis after months—or even years—of persistent symptoms.

Key Causes of Sinus Tarsi Syndrome

1. Recurrent Ankle Sprains

Repeated inversion ankle sprains are the leading cause of STS. Each sprain can damage the interosseous talocalcaneal ligament and cervical ligament, leading to chronic inflammation within the sinus tarsi.

A sports physiotherapist colleague once remarked during a case discussion, “It’s rarely the first sprain that causes trouble—it’s the third or fourth that quietly destabilises the subtalar joint.”

Research published in The American Journal of Sports Medicine supports this, showing a strong association between chronic ankle instability and sinus tarsi pain.

2. Excessive Foot Pronation

Overpronation increases compressive forces in the sinus tarsi. Over time, this leads to irritation, synovitis, and pain.

Patients with flat feet often describe discomfort during prolonged walking or standing—particularly on uneven ground.

3. Poorly Rehabilitated Injuries

One uncomfortable truth in clinical practice is that many ankle sprains are never fully rehabilitated. Pain settles, swelling reduces, and activity resumes—but proprioception and strength deficits remain.

Without proper neuromuscular retraining, subtle instability persists, setting the stage for STS.

4. Inflammatory or Degenerative Conditions

Conditions such as rheumatoid arthritis or subtalar osteoarthritis can inflame the sinus tarsi. While less common, these causes should always be considered, especially in non-traumatic cases.

Common Symptoms Patients Report

Sinus Tarsi Syndrome does not always announce itself loudly. Typical symptoms include:

• Deep, aching pain on the outer ankle
• Tenderness when pressing just in front of the ankle bone
• Instability or fear on uneven surfaces
• Pain worsening after activity rather than during

Patients often say things like, “It doesn’t hurt all the time, but I don’t trust my foot.” That loss of confidence is a hallmark of STS.

How Sinus Tarsi Syndrome Is Diagnosed

Diagnosis is primarily clinical, supported by imaging when needed.

Clinical Examination

Physiotherapists and sports clinicians assess:

• History of ankle sprains
• Localised sinus tarsi tenderness
• Subtalar joint mobility
• Balance and proprioception

A diagnostic injection of local anaesthetic into the sinus tarsi that temporarily relieves pain is often considered confirmatory, as noted in Foot & Ankle International.

Imaging

MRI may show inflammation or scar tissue but is not always conclusive. Importantly, a normal MRI does not rule out STS.

Why Physiotherapy Is the Gold-Standard Treatment

While injections or surgery are sometimes discussed, evidence consistently supports physiotherapy as the first-line and most sustainable treatment.

A systematic review in Physical Therapy in Sport found that conservative management, particularly exercise-based rehabilitation, leads to significant improvements in pain and function for patients with sinus tarsi symptoms.

Physiotherapy Treatment for Sinus Tarsi Syndrome

1. Pain and Inflammation Management

Early management focuses on reducing irritation through:

• Activity modification
• Ice application post-activity
• Manual therapy to offload the subtalar joint

This is not about rest alone, but strategic load management.

2. Restoring Subtalar Joint Mobility

Restricted subtalar motion increases sinus tarsi compression. Gentle mobilisation techniques, performed by trained physiotherapists, help restore normal joint mechanics.

In my own practice, patients often report reduced pain after just a few sessions of targeted joint mobilisation.

3. Strengthening Key Muscle Groups

Strength deficits around the ankle and hip are central to STS. Focus areas include:

• Peroneal muscles
• Tibialis posterior
• Gluteus medius

Strengthening is progressive and functional—not just resistance bands on a treatment table.

4. Proprioception and Balance Training

This is where long-term success is built.

Exercises progress from:

• Single-leg stance
• Wobble board control
• Sport- or task-specific drills

According to research in Gait & Posture, proprioceptive training significantly reduces recurrence of ankle instability-related conditions.

5. Footwear and Orthotic Advice

Footwear with poor rearfoot stability often aggravates symptoms. In some cases, custom orthotics that limit excessive pronation reduce sinus tarsi compression.

This is always assessed individually—there is no one-size-fits-all solution.

How Long Does Recovery Take?

With consistent physiotherapy, most patients experience meaningful improvement within 6–12 weeks. Chronic cases may require longer, but outcomes are generally favourable.

The key predictor of success is adherence—not just attendance.

When Is Surgery Considered?

Surgery is rare and reserved for cases that fail extensive conservative management. Procedures may involve sinus tarsi debridement or stabilisation of the subtalar joint.

Most evidence suggests surgery should be a last resort.

Sinus Tarsi Syndrome Treatment at Cure On Call

At Cure On Call, we provide evidence-based physiotherapy for Sinus Tarsi Syndrome through experienced clinicians who specialise in musculoskeletal and sports rehabilitation. Our approach combines detailed assessment, personalised exercise programmes, manual therapy, and guided recovery plans—delivered conveniently through home visits and tele-rehabilitation where appropriate. We focus not just on pain relief, but on restoring confidence, stability, and long-term foot health.

Practical Takeaways You Can Apply Today

• Do not ignore recurring ankle sprains—even if pain settles
• Avoid unstable footwear during recovery
• Begin balance training early, under professional guidance
• Seek physiotherapy if ankle pain persists beyond 4–6 weeks

Small, consistent actions prevent chronic problems.

Frequently Asked Questions (FAQs)

Is Sinus Tarsi Syndrome permanent?

No. With appropriate physiotherapy and load management, most cases resolve successfully.

Can I exercise with Sinus Tarsi Syndrome?

Yes—but exercise selection and progression are critical. Avoid uneven terrain initially.

Do I need an MRI for diagnosis?

Not always. Clinical assessment is often sufficient.

Can orthotics cure Sinus Tarsi Syndrome?

They can help reduce symptoms but work best alongside physiotherapy.

Final Thoughts

Sinus Tarsi Syndrome is not a life sentence—but it does demand proper attention. When treated thoughtfully, with expert-led physiotherapy and patient engagement, outcomes are consistently positive.

If you have experienced persistent ankle pain or instability, I encourage you to start a conversation. Have you had repeated ankle sprains that never felt quite right afterwards? Share your experience—or take the next step toward professional assessment.

Your ankle stability matters more than you think.

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