Sinus tarsi syndrome is somewhat paradoxical in that it can be caused by inversion, as in an ankle sprain damaging the structures in the sinus tarsi by stretching them; and it can also be caused by eversion, as in a pronated foot with high forces pushing the subtalar joint to end range of motion and causing compression forces at the bony end range of motion. The structures in the sinus tarsi and their role is very complex and poorly understood. A better understanding will better help direct therapeutic approaches. However, in both the pain is on the outside of the ankle joint. Generally, the inversion type responds well to physical therapy intervention and the eversion type responds well to foot orthotics.
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