Sports Medicine: Sinus Tarsi Syndrome - The Ankle Pain That Isn't

Patients commonly complain about painful heels and ankles. This problem is sometimes challenging and can become resistant to standard treatment such as rest, ice, bandaging, physical therapy, oral anti-inflammatories and injections. No doubt, many patients have encountered their primary care physician or other specialist yet despite their doctors’ best efforts they remain unimproved.

This past week, two separate patients came to my office with complaints of ankle pain that was not getting any better despite treatment by therapists and doctors just as I described. Sadly, one of the patients had pain for the last three years and was unable to walk for more than a couple blocks without excruciating pain. She was normally very active and her limitations nearly had her in tears.  My comprehensive sports history and exam revealed what appeared to be generalized ankle pain however X-rays were negative for fracture or dislocations. Some clues surfaced from her history however.

Patience and a keen eye yield results…

A simple diagnostic block at the ankle helped rule out internal ankle pain. At that point, I suspected that the patient actually had a much more subtle injury (one that might not be picked up on MRI) and therefore ordered one additional diagnostic/therapeutic block. The patient came back a week later saying “it’s fantastic… I can walk without pain.”  That made the diagnosis of sinus tarsi syndrome. The patient walked out of the office that day and was discharged pain free. The other patient, which I did not mention, had exactly the same problem with a very similar history and she too is walking pain-free.

The good thing about this problem is that if the correct diagnosis is made, treatment is relatively simple.  Diagnostic and therapeutic blocks are often helpful if not outright curative. If the foot is unstable, flat posted orthotics are helpful long-term. Surgery, when it is an option, is relatively minor and highly successful.

The moral of the story?  If you or someone you know has chronic “ankle pain” that has not responded to “ankle” treatments. You might consider an alternative diagnosis such as sinus tarsi syndrome – “the ankle pain that isn’t”

We often see patients from all over the Bay Area and I would be happy to discuss this particular problem or any other problem in greater detail should the need arise.

Become pain free for good. Click here or Call us now at  510-521-3410  ~ Dr. Jeffrey J Niccoli  Board-Certified, Alameda Family Podiatry Group. Serving  Bay Area patients from San Francisco, Oakland, Fremont, and Alameda



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