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Saturday, October 17, 2015

Sinus Tarsi Syndrome: Email Advice

The sinus tarsi is a canal that runs within the subtalar joint between the talus and calcaneus. It can give symptoms below the ankle in any of the 4 directions: back, inside, outside or top of the foot (this being the least). An injection of local anesthetic can be a diagnostic tool to locate the source of the pain. When the doctor feels confident in that diagnosis, they may combine cortisone with the local to get longer lasting relief. This patient seems to have gotten the diagnostic part with the initial pain relief post shot, so the source of the pain seems to be likely from the subtalar joint. 

Hey Dr. Blake I wanted to ask. I had experienced some strain on my left foot and saw a podiatrist today. According to the doctor it was deemed a congenital left sinus tarsi syndrome. I had been experiencing a strange pain on that area for 2 weeks. Its like tender muscle which wouldn't go away and hurt with my work shoes which are slip-resistant rubber-soled shoes provided by the company. I have a job that consists me of being on my feet a lot. I know for a fact that the work shoes I had 2 weeks ago on a Tuesday was the cause of the strain on my left foot and that weird pain because the shoe got wet by the rain and the work shoe I had was of the steeled-toe kind which is a bit heavy. I hadn't had my superfeet inserts in them because I hadn't gotten pain before only when the shoe got wet. I initially had seen a general doctor 2 weeks ago and was given a ankle boot, a soft shoe and 800 mg ibupropen to be taken 3 times daily as needed with pain. Still the pain came. So now today Friday 10/2/15 I was able to land an appt with a podiatrist to get a thorough observation. She gave me a cortizone shot which at first relieved me of the pain when I walked but in the afternoon around 3pmish, I felt my left foot inflamed due to the shot I think. I even had lunch and took one tablet of ibupropen and I still feel it. I had tried to ice the area for 10 min and I still have it. I was told I'd be fine to return to work normally but I feel like the shot made it worse seeing that it feels more painful to walk. I was also given a new ankle brace to wear to replace the old one, but again feels like I can't walk a normal stride on that left foot. Do you have any recommendations? I did email the doctor about this too. Thanks. 

Dr Blake's comment:

It can take the cortisone up to 2 weeks to really work (if given in the right spot). Unfortunately, the shot can be irritative and cause more pain for awhile (typically only 4 days). Ice for 4 days post shot, and see how the symptoms go. By the time you read this you should be at the 2 week point, so I hope you are doing much better. Sinus tarsi is a pronation produced problem, and many braces are actually designed to pronate us. So, if the brace does not feel great, remove, and find another or just limit your activities. Hope this helps some. Rich

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Thank you very much for leaving a comment. Due to my time restraints, some comments may not be answered.I will answer questions that I feel will help the community as a whole.. I can only answer medical questions in a general form. No specific answers can be given. Please consult a podiatrist, therapist, orthopedist, or sports medicine physician in your area for specific questions.