Sinus Tarsi Syndrome Michigan | Lateral Hindfoot Pain Specialist

Quick answer: Sinus Tarsi Syndrome Michigan is a clinical condition that responds to evidence-based treatment when caught early. Symptoms include pain, swelling, and altered function. Diagnosis requires clinical exam, often imaging. Treatment ladder: conservative care first (4-6 weeks), then targeted interventions if needed. Book online, or call (810) 206-1402.

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Medically reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatric Surgeon — Balance Foot & Ankle, Howell & Bloomfield Township, MI. Last updated April 2026.

Sinus Tarsi Syndrome Michigan

Sinus tarsi syndrome (STS) is a clinical condition characterized by pain and tenderness in the sinus tarsi — the small canal between the talus and calcaneus on the lateral side of the hindfoot. It is a frequently overlooked cause of chronic lateral ankle and hindfoot pain following ankle sprains or in patients with flatfoot deformity. Dr. Tom Biernacki DPM at Balance Foot & Ankle provides accurate diagnosis and effective treatment for sinus tarsi syndrome in Michigan at our Howell, Brighton, and Bloomfield Township locations.

What Is the Sinus Tarsi?

The sinus tarsi is a cone-shaped canal between the talus and calcaneus, running from the lateral to medial hindfoot. It contains interosseous talocalcaneal ligaments, synovial tissue, nerve endings, and small blood vessels. The ligaments within the sinus tarsi provide important proprioceptive feedback for ankle and subtalar joint stability. When these structures are torn or inflamed — typically after an inversion ankle sprain — the resulting synovitis, fibrosis, and nerve irritation produce chronic lateral hindfoot pain.

Causes

• Prior ankle sprain (most common — 70% of STS cases)
• Chronic ankle instability with repetitive subtalar loading
• Flatfoot deformity (excessive pronation compresses the sinus tarsi)
• Rheumatoid or inflammatory arthritis
• Post-calcaneal fracture scarring

Symptoms

• Point tenderness directly over the sinus tarsi (lateral hindfoot, just in front of the lateral malleolus)
• Pain with inversion and eversion of the subtalar joint
• A feeling of “giving way” or instability in the hindfoot
• Worsened by walking on uneven terrain
• Relief when the foot is off the ground

Diagnosis

The sinus tarsi injection test is both diagnostic and therapeutic — local anesthetic injected into the sinus tarsi under ultrasound or fluoroscopic guidance provides complete temporary relief if the sinus tarsi is the pain source. MRI shows increased signal (edema/inflammatory change) within the sinus tarsi and can assess interosseous ligament integrity and articular cartilage. Weight-bearing CT evaluates subtalar joint alignment and identifies tarsal coalition (which can mimic STS).

Treatment

Conservative treatment: Custom orthotics with lateral hindfoot posting control excessive pronation and reduce sinus tarsi compression. Physical therapy targeting subtalar proprioception and peroneal strengthening. Activity modification to avoid uneven terrain.

Corticosteroid injection into the sinus tarsi under ultrasound guidance provides significant relief in 70–80% of patients, with effects lasting 3–6 months. Repeat injection may be performed at 3–6 month intervals.

Surgical arthroscopic debridement of the sinus tarsi (synovectomy, interosseous ligament debridement) is performed through small lateral portals for patients failing 3–6 months of conservative care. Excellent outcomes with 80–90% patient satisfaction.

Frequently Asked Questions

Schedule your sinus tarsi evaluation at Balance Foot & Ankle in Howell, Brighton, or Bloomfield Township, Michigan.

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