Hi, my physio suspects I have sinus tarsi syndrome, I get a quite intense stabbing pain in that area when cycling hard. I have found I can moderate this pain slightly by moving my cleats further back towards the heel.
I have had for the past 2 weeks - have rested it for 3 days initially and started back on light gear cycling only but it’s persisting.
He states this is one of the few areas he would reccomend a steroid injection - so waiting to see a consulatant who I’ve been seeing for a different tendon problem on the other ankle.
The link is a recent MRI (taken on both ankles - the sinus tarsi is on the left ankle) done in april prior to any symptoms appearing - is there anything in there that suggests a possible predisposistion to sinus tarsi?
Can I continue to cycle thought the pain without any major issues (as I understand one of the options is to remove everything in the area anyway - so I amssuming it can’t be that improtant - so it’s only pain and I’m not damaging any important ankle structures?)
Yes, you can cycle through this. I often do a steroid injection into the sinus tarsi and it generally does work very well (better than just rest/time off for most type-A athletes for example).
Yes, you can cycle through this. I often do a steroid injection into the sinus tarsi and it generally does work very well (better than just rest/time off for most type-A athletes for example).
I did have one other question - If i have the cortisone, do I need to stop (heavy?)training and if so far how long ? (Have read conflicting advice on this)
What you have read is likely in regards to “cortisone” (which isn’t really used any longer) in a joint and periods of rest. The sinus tarsi isn’t really a joint technically (although a portal to the middle facet of the subtalar joint). People occasionally will experience a steroid flare reaction with an increase in pain, but that subsides within 48 hours in most cases. I would simply take off the day of the injection only, then back at it.
Hello - I know this thread has been dead for a while, just wondering what your outcome was. I have a suspected case of sinus tarsi that has been going on for 2+ years and wanted to know how your injection / therapy went.
Hi - I had an injection a few weeks after this post - this settled it greatly and saved the season - no more intense pain and I was back to full gas training within the week (I could still senes some kind of twinge during hard rides but nothing that stopped anything - I guess this is because you become ‘ultra’ aware and self conscious about prev injuries.)
Last month or so I could sense the problem surfacing again so I saw a different foot and ankle consultant who was ultra cautious and got a radiologist to give me a guided MRI anasthetic injection directly into the sinus tarsi to verify it was the sinus tarsi - which confirmed it was (the pain went after the injection when I did my ‘stress’ positions on the foot)
I go back to see the consultant this thursday to discuss my options.
Hopefully rroof will read and offer his comments - the radiologist was of the opinion that I should really have any more ‘steroid’ injections as he said the sinus tarsi was a joint and too many injections could damage the subtalar (I appreciate rroof pointed out this was a ‘portal’ to the joint). Not sure what the consultant will say - though neither seem sports orientated.
I would much prefer to have one or 2 injections a season (if needed) rather than an operation to clean it out as there seems to be a long lay off and complications.
I could ‘baby’ the problem through winter and save the injection(s) in the bank for when I start intense training and racing.?
Nice follow up post that might assist others since most people (including physicians) know very little about sinus tarsi syndrome.
As far as how many injections one can have there … that is highly debatable with very little hard evidence either way. The very generic rule of thumb has been no more than 3 per joint per year. Since this particular injection is generally so beneficial (esp for active people), I absolutely have no issues with doing it since there is no real “rehab” for it other than complete rest (which most type-A triathletes aren’t going to do). Obviously, trying to find out what is causing it if possible would be ideal! Surgery is NOT terribly effective and I rarely recommend.
So essentially with the pain from sinus tarsi that I have not much besides injections can be done to solve the problem? Im trough with my 3 injections for the year and now have pain once again. Why is this such a hard problem to solve?