Sinus Tarsi Syndrome

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Sinus Tarsi Syndrome





John Miller Physiotherapist


Shane Armfield Physiotherapist

Article by
John Miller,
Shane Armfield


Sinus tarsi syndrome physiotherapy may help reduce lateral ankle pain, restore steadier footing, and guide a safe return to walking, work, and sport.

What is sinus tarsi syndrome?

Sinus tarsi syndrome describes pain in a small channel on the outside of your ankle, between the talus and calcaneus bones. Many people notice soreness when they press the area, walk on uneven ground, or turn quickly. It often follows an ankle sprain, although it can also build up from repeated loading and foot mechanics.

Next, it helps to know the bigger picture. Sinus tarsi pain can link with subtalar joint irritation, scar tissue, or ligament strain. For a broader overview of causes and options, start with our ankle pain guide.

Sinus tarsi syndrome physiotherapy assessment explaining lateral ankle pain
Sinus Tarsi Syndrome Physiotherapy Assessment – Lateral Ankle Pain

Why does sinus tarsi syndrome happen?

Several factors can irritate the sinus tarsi region. Common triggers include:

  • Previous ankle sprain (especially repeated “rolling” injuries) that leaves lingering stiffness, swelling, or instability.
  • Chronic ankle instability where the ankle gives way and the subtalar joint works harder to control the foot. See chronic ankle instability (CAI).
  • Subtalar joint overload from higher training loads, lots of hills, trail running, or court sports with cutting and pivoting.
  • Foot mechanics such as over-pronation or a flatter foot posture, which can increase compressive stress through the hindfoot. Learn about orthotics.
  • Neighbouring tendon issues that change how you load the outside of the ankle, including peroneal tendinopathy.

Symptoms: what does it feel like?

Many people describe:

  • Localised tenderness on the outside/front of the ankle (just in front of the ankle bone).
  • A dull ache after walking, running, or standing for long periods.
  • Discomfort on uneven surfaces, trails, or side slopes.
  • A sense of “wobble” or reduced confidence on that foot.
  • Occasional swelling or a feeling of fullness in the area.

People also ask: can sinus tarsi syndrome show on MRI?

Imaging may help when symptoms persist, recur, or fail to improve with a sensible rehab plan. An MRI can sometimes show inflammation, scar tissue, ligament issues, or joint irritation. Even so, scans do not always match symptoms. Because of that, your assessment findings and response to treatment still guide most decisions.


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How a physiotherapist may assess sinus tarsi pain

Assessment usually focuses on three things: what started it, what loads it, and what is not controlling well.

  • History: prior sprains, “giving way”, training changes, footwear, and surfaces.
  • Palpation: local tenderness and swelling patterns.
  • Movement tests: ankle and subtalar range, plus pain with twisting or single-leg tasks.
  • Strength and control: calf strength, hip control, balance, and landing mechanics.
  • Rule-outs: similar issues such as anterior ankle impingement or posterior ankle impingement.

Treatment options that often help

1) Settle pain and irritation

Early care may include short-term activity changes, swelling control, and load management. Simple steps like reducing hills, limiting uneven surfaces, and spacing running sessions can calm symptoms while you keep moving.

2) Rebuild strength and control

Rehab often targets the calf, peroneals, and the muscles that control the arch and hindfoot. Balance and proprioception work matters too, particularly after a sprain. If your symptoms began after a sprain, see our sprained ankle guide and ankle sprain prevention tips.

3) Improve foot and shoe support when needed

Some people do better with footwear changes or orthotics, especially if pronation or hindfoot control loads the sinus tarsi. A physiotherapist may also suggest short-term taping or bracing for training and return to sport.

4) Guided return to sport

A graded plan usually works best: first restore comfortable walking, then build single-leg strength and balance, and then progress to hopping, cutting, and sport-specific drills. Our sports injury physiotherapy page explains how this progression often works.

5) Injections or specialist review (when appropriate)

Some people consider injections if pain remains high despite good rehab. Research suggests corticosteroid injections may help in the short term, although symptoms can return in some cases. If symptoms persist or instability remains, your clinician may discuss further imaging or medical review. For general ankle injury guidance, see Healthdirect’s sprained ankle overview.

Related PhysioWorks pages

What to do next

If you have outside-of-ankle pain that lingers after a sprain, or your ankle feels unsteady on uneven ground, book an assessment. A physiotherapist can identify the likely driver of your sinus tarsi pain, then map out the next steps to restore confidence, strength, and steady footing.


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References

  1. Willegger M, Bouchard M, Veljkovic A, et al. The evolution of sinus tarsi syndrome—what is the underlying pathology?—a critical review. J Clin Med. 2023;12(21):6878. https://pmc.ncbi.nlm.nih.gov/articles/PMC10650822/
  2. Arshad Z, Lau Y, Rahman S, et al. Current concepts in sinus tarsi syndrome: a scoping review. Foot Ankle Surg. 2021;27(7):739-747. https://pubmed.ncbi.nlm.nih.gov/32978087/
  3. Pereira BS, Hamid KS, Soni A, et al. Current concepts in subtalar instability. Foot Ankle Orthop. 2021;6(3). https://pmc.ncbi.nlm.nih.gov/articles/PMC8381447/
  4. Xu X, et al. Clinical observation of sinus tarsi syndrome after lateral ankle sprain. 2024. https://pubmed.ncbi.nlm.nih.gov/38664210/

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