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The response to the question below was authored by Marc Mitnick DPM
ANKLE PAIN, DIAGNOSE "SINUS TARSI SYNDROME"
by Jackie
(San Diego, California)
Hi I am a mail carrier and have been doing it for over 9 years on 08/16/2011 I sprained my right ankle while crossing a front yard (uneven dried grass) carrying my satchel (mailbag) half way full may be 15 pounds. I did not have a lot a pain, actually I was getting better the next 3 days. I noticed that if I walked over 4 hrs or carrying a lot mail I will get the pain back and started limping and swelling ankle. It was a on and off condition. After two weeks a callus on the left foot started hurting me, put a callus remover on 09/10/11 and callus was gone on 09/12/11. Since I am diabetic, I had a reaction and my foot got infected. I was on crutches for a week. I returned to work and the infected foot (left) was ok, but the right ankle was still bothering me, the same on/off pain. I seek for medical help, x-rays look normal on 09/26/11, returned to work with no restriction only with an ankle support. My condition was the same and returned to the doctor with the same problem, on/off pain and ankle swelling. Finally I was put off from work on 10/27/11.Had a aq-boot for 2 months, cast for 3 weeks and air cast for other 3 weeks and no walking for more that 20 min. On 02/15/12 I had a MRI and I was told that I have fluid in my ankle and torn ligament, diagnosed with "SINUS TARSI SYNDROME". I had 2 shots for pain, and going to physical therapy, I don't feel any improvement. Since I am a mail carrier do you think this could be a chronic condition due to the type of job that I have? Or it was only caused because I sprained my ankle?
RESPONSE
Hi Jackie,
Unfortunately, without knowing much about you it is difficult to tell whether or not this is going to be a chronic condition.
Your occupation certainly lends itself to the notion that there may be a problem going forward for the simple obvious reason that you walk on the foot and ankle a great deal.
On the basis of what you report the MRI showed, you have fluid in the ankle joint which means it is inflamed, you have a torn ligament which until it is repaired will probably give you some degree of pain and you have sinus tarsi syndrome which is an inflammation of the joint underneath the ankle joint. So basically, you have inflammation of two joints and a torn ligament.
In most cases, resting the foot and ankle, being non-weightbearing should have resolved the problem as that is standard procedure. Physical therapy in theory at least should have expedited the healing process and one would have thought you would be much better by now.
That obviously is not the case. It has been 18 months and you still have issues. Yes, I suppose the infection on the other foot did set you back somewhat as it then required you to put more weight on the injured foot and ankle, but nevertheless, at the very least you should be showing significant improvement at this point and you are not.
Whether or not you can reassigned to a less physically demanding job within the post office is something you may want to explore as it seems to be, walking a route is going to be an issue. Theoretically, wearing an ankle and foot brace may relieve the pain, but I am not sure so that will allow you to walk the long routes that are required of you.
Marc Mitnick DPM
DISCLAIMER
Comments for ANKLE PAIN, DIAGNOSE "SINUS TARSI SYNDROME"
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ADDITIONAL REFERENCES
University of Rochester Medical Center
American Academy of Pediatrics
Columbia University Department of Rehabilitation
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