Ultrasound-Guided Cortisone Injections for Sinus Tarsi Syndrome

 

Introduction

Sinus Tarsi Syndrome is a painful condition affecting the lateral aspect of the ankle, often resulting from repetitive strain, ligament instability, or previous ankle injuries. It is characterised by chronic pain and tenderness in the sinus tarsi, a small anatomical cavity located between the talus and calcaneus bones. Individuals with this condition often experience pain during weight-bearing activities, instability, and difficulty walking on uneven surfaces.

At Alton Pain Clinic, ultrasound-guided cortisone injections may be considered as a targeted treatment approach to help reduce inflammation and pain associated with Sinus Tarsi Syndrome. This blog provides a detailed overview of the condition, including anatomy, pathology, causes, symptoms, diagnosis, and treatment options, with a focus on how cortisone injections work and their mechanism of action.

Anatomy of the Sinus Tarsi

The sinus tarsi is a cone-shaped space located on the outer side of the ankle, between the talus (ankle bone) and calcaneus (heel bone). It is an important anatomical structure that contains:

✔ Ligaments — The interosseous talocalcaneal ligament and the cervical ligament provide stability to the subtalar joint.
✔ Blood vessels and nerves — Small vessels and nerve endings pass through the sinus tarsi, contributing to pain perception.
✔ Synovial lining — The sinus tarsi contains a thin synovial membrane, which can become inflamed due to injury or overuse.

When the ligaments or soft tissues within the sinus tarsi become irritated or inflamed, it can lead to persistent pain and instability, characteristic of Sinus Tarsi Syndrome.

Pathology of Sinus Tarsi Syndrome

Sinus Tarsi Syndrome typically results from chronic irritation of the soft tissues within the sinus tarsi, leading to:

✔ Inflammation of the synovial lining, causing pain and swelling.
✔ Fibrosis and scar tissue formation, restricting movement and function.
✔ Instability of the subtalar joint, leading to mechanical overload.
✔ Compression of nerve endings, increasing pain sensitivity.

Over time, if left untreated, chronic inflammation may lead to degeneration of the surrounding tissues, worsening symptoms and ankle instability.

Causes of Sinus Tarsi Syndrome

Several factors contribute to the development of Sinus Tarsi Syndrome, including:

1. Repetitive Ankle Sprains

  • Ankle sprains can lead to ligamentous laxity and inflammation within the sinus tarsi.

2. Overuse and Repetitive Strain

  • Athletes or individuals engaged in high-impact activities may develop microtrauma in the sinus tarsi region.

3. Subtalar Joint Instability

  • Weak ligaments or previous ankle injuries can result in excessive motion, leading to irritation of the soft tissues.

4. Flat Feet (Pes Planus) or Overpronation

  • Biomechanical abnormalities place excessive stress on the sinus tarsi, contributing to chronic irritation.

5. Arthritis of the Subtalar Joint

  • Degenerative or inflammatory arthritis can lead to pain and inflammation within the sinus tarsi.

Symptoms of Sinus Tarsi Syndrome

✔ Pain on the outer side of the ankle — Typically worsens with activity.
✔ Tenderness in the sinus tarsi region — Often felt when pressing on the affected area.
✔ Instability of the ankle — A feeling of “giving way,” especially on uneven surfaces.
✔ Stiffness and restricted movement — Difficulty with side-to-side movements.
✔ Swelling in the lateral ankle — May be associated with inflammation of the subtalar joint.

Symptoms worsen with weight-bearing activities and may persist for months if left untreated.

Diagnosis of Sinus Tarsi Syndrome

Clinical Assessment at Alton Pain Clinic

A clinician will evaluate the ankle using:

✔ Medical History — Assessing previous injuries, activity levels, and symptoms.
✔ Physical Examination — Palpation of the sinus tarsi and range of motion tests to evaluate joint stability.

Imaging Studies

  1. Ultrasound Scan — Provides real-time imaging to detect soft tissue inflammation and fluid accumulation.

Treatment Options for Sinus Tarsi Syndrome

Conservative Management

✔ Rest and Activity Modification — Reducing impact activities can help prevent further irritation.
✔ Supportive Footwear and Orthotics — Proper arch support can offload pressure on the sinus tarsi.
✔ Physiotherapy — Strengthening exercises to improve ankle stability and biomechanics.
✔ Pain Relief Strategies — Ice therapy, anti-inflammatory medications (NSAIDs), and compression techniques may help manage pain.

Ultrasound-Guided Cortisone Injections for Sinus Tarsi Syndrome

For persistent pain and inflammation, ultrasound-guided cortisone injections may be considered as a minimally invasive option to help alleviate symptoms.

Mechanism of Action of Cortisone Injections

Cortisone injections contain corticosteroids, which:
✔ Reduce inflammation — Inhibiting the release of inflammatory mediators in the sinus tarsi.
✔ Alleviate swelling — Minimising fluid accumulation and tissue irritation.
✔ Provide temporary pain relief — Allowing improved mobility and function.

Why Use Ultrasound Guidance?

At Alton Pain Clinic, ultrasound guidance ensures:
✔ Accurate medication placement within the sinus tarsi.
✔ Reduced risk of complications by avoiding nearby structures.
✔ Enhanced treatment precision and effectiveness.

Procedure Overview

  1. Preparation — The area is cleaned, and a local anaesthetic is applied.
  2. Ultrasound Imaging — The sinus tarsi is visualised in real time.
  3. Injection — A combination of corticosteroid and local anaesthetic is administered.
  4. Post-Injection Care — Patients may be advised to limit high-impact activities for a few days.

Why Choose Alton Pain Clinic for Sinus Tarsi Syndrome Treatment?

✔ Experienced clinicians specialising in musculoskeletal conditions.
✔ Advanced ultrasound-guided injection techniques.
✔ Comprehensive, patient-centred approach tailored to individual needs.

Conclusion

Sinus Tarsi Syndrome is a common cause of lateral ankle pain, often resulting from recurrent sprains, instability, or biomechanical abnormalities. While conservative management may help, ultrasound-guided cortisone injections can provide targeted relief by reducing inflammation and irritation in the sinus tarsi.

At Alton Pain Clinic, we offer expert musculoskeletal care, ensuring precise and effective treatment to help patients regain comfort and mobility.


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