Corticosteroid, Platelet-Rich Plasma, and Ozone Injections for Sinus Tarsi Syndrome

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  • 1 Department of Orthopedics and Traumatology, Agrı Training and Research Hospital, Ağrı, Turkey. Dr. Toy is now with Istanbul Basaksehir Pine and Sakura City Hospital, Istanbul, Turkey.
  • | 2 Department of Orthopedics and Traumatology, Ataturk University Faculty of Medicine, Erzurum, Turkey. Dr. Tuncer is now with Department of Orthopedics and Traumatology, Altinbas University Medical Park, Bahçelievler Hastanesi, Istanbul, Turkey.
  • | 3 Department of Orthopedics and Traumatology, Kastamonu University Faculty of Medicine, Kastamonu, Turkey.


Background: Sinus tarsi syndrome is characterized by permanent pain on the anterolateral side of the ankle. This pain occurs due to chronic inflammation, characterized by fibrotic tissue remnants and synovitis accumulation after repeated traumatic injuries. Few studies have documented the outcome of injection treatments for sinus tarsi syndrome. We sought to determine the effects of corticosteroid and local anesthetic, platelet-rich plasma, and ozone injection on the sinus tarsi syndrome.

Methods: Sixty patients diagnosed with sinus tarsi syndrome were randomly divided into three groups. Patients in the first group received corticosteroid and local anesthetic, patients in the second group received platelet-rich plasma, and patients in the third group were given ozone injections. Outcome measures were Visual Analog Scale (VAS), American Orthopedic Foot and Ankle Society Ankle-Hindfoot Scale (AOFAS), Foot Function Index (FFI), and Foot-Ankle Outcome Score (FAOS). Outcome measures were evaluated by comparing pre-intervention and post-injection 1-month, 3-month, and 6-month follow-ups.

Results: At the end of the 1st month, third month, and sixth month after injection, significant improvements were observed in all three groups compared to the baseline (p < .001 for all comparisons). In the 1st and third months, the improvements in AOFAS scores were similar in Groups 1 and 3; those in Group 2 were lower (p = .001 and p = .004, respectively). In the 1st month, the improvements in FAOS scores were similar in Groups 2 and 3; those in Group 1 were higher (p < .001). During the 6-month follow-up period, there was no statistically significant difference in VAS and FFI results between all three groups (p > .05).

Conclusions: Corticosteroid and local anesthetic or platelet-rich plasma or ozone injections could provide clinically significant functional improvement for at least six months in patients with sinus tarsi syndrome.

Corresponding author: Serdar Toy, MD; Istanbul Basaksehir Pine and Sakura City Hospital, Department of Orthopedics and Traumatology. Basaksehir Olimpiyat Bulvari Yolu, 34480, Basaksehir, Istanbul, Turkey. (E-mail: