Post-traumatic sinus tarsi syndrome: An anatomical and radiological study

The literature reports that 70% of the cases of sinus tarsi syndrome are post-traumatic, following an inversion sprain, and that 30% result from inflammatory disorders, such as rheumatoid arthritis, ankylosing spondylitis, and gouty arthritis. However, in the case presented, talipes equinovarus deformity and sinus tarsi syndrome coexisted. One of the corrective goals in the management of the talipes equinovarus deformity is the realignment of the articulation between the medial plantarly deviated talar head and the anteromedial segment of the calcaneus. The calcaneus must be rotated from a plantarflexed position into a dorsiflexed position. The posterior tubercle will be moved down and in, with the anterior process moved up and out away from the talar head. By correcting the plantarflexed varus attitude of the calcaneus, it is put in a valgus position that often closes down the sinus tarsi upon weightbearing. This compression may result in pain over the lateral aspect of the midfoot with hindfoot instability, as seen in the case presented. As a result of the abnormal anatomical relationship of the talus and calcaneus, the patient developed severe pain in the sinus tarsi. Based on the medical history and present postoperative results, the authors find a long-term sequela of talipes equinovarus deformity to be sinus tarsi syndrome.

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Denervation of the Sinus Tarsi for Chronic Post-Traumatic Lateral Ankle Pain

Orthopedics ◽

10.3928/0147-7447-20020801-22 ◽

2002 ◽

Vol 25 (8) ◽

pp. 849-851

Author(s):

A Lee Dellon

Keyword(s):

Ankle Pain ◽

Lateral Ankle ◽

Sinus Tarsi ◽

Post Traumatic

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MR imaging of the tarsal sinus and canal: normal anatomy, pathologic findings, and features of the sinus tarsi syndrome.

Radiology ◽

10.1148/radiology.186.1.8416571 ◽

1993 ◽

Vol 186 (1) ◽

pp. 233-240 ◽

Cited By ~ 86

Author(s):

M A Klein ◽

A M Spreitzer

Keyword(s):

Mr Imaging ◽

Normal Anatomy ◽

Sinus Tarsi ◽

Sinus Tarsi Syndrome ◽

Pathologic Findings

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Incidence of Post-Traumatic Arthrosis after Primary Healing of Scaphoid Fractures: A Clinical and Radiological Study

Journal of Hand Surgery (European Volume) ◽

10.1016/0266-7681_90_90041-2 ◽

1990 ◽

Vol 15 (1) ◽

pp. 11-13

Author(s):

G. LINDSTRÖM ◽

A. NYSTRÖM

Keyword(s):

Retrospective Study ◽

Radiological Study ◽

Scaphoid Fractures ◽

Radiological Evidence ◽

Post Traumatic ◽

Primary Healing

In a retrospective study of 229 patients with healed fractures of the waist of the scaphoid, the incidence and development of post-traumatic radiocarpal arthrosis was studied. With a minimum follow-up period of seven years, 5.2% of patients showed radiological evidence of radiocarpal arthrosis. It is concluded that an alteration of the carpal dynamics, due to deformation and shortening of the scaphoid, is the most likely cause of post-traumatic arthrosis after primary healing of scaphoid fractures.

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Six out of ten patients with sinus tarsi syndrome returned to pre-injury type of sport after subtalar arthroscopy

Knee Surgery Sports Traumatology Arthroscopy ◽

10.1007/s00167-020-06385-8 ◽

2020 ◽

Author(s):

Kenny Lauf ◽

Jari Dahmen ◽

J. Nienke Altink ◽

Sjoerd A. S. Stufkens ◽

Gino M. M. J. Kerkhoffs

Keyword(s):

Clinical Outcomes ◽

Median Time ◽

Outcome Measures ◽

Return To Sport ◽

Injury Type ◽

Sinus Tarsi ◽

Sinus Tarsi Syndrome ◽

Improved Performance

Abstract Purpose The purpose of this study was to determine multiple return to sport rates, long-term clinical outcomes and safety for subtalar arthroscopy for sinus tarsi syndrome. Methods Subtalar arthroscopies performed for sinus tarsi syndrome between 2013 and 2018 were analyzed. Twenty-two patients were assessed (median age: 28 (IQR 20–40), median follow-up 60 months (IQR 42–76). All patients were active in sports prior to the injury. The primary outcome was the return to pre-injury type of sport rate. Secondary outcomes were time and rate of return to any type of sports, return to performance and to improved performance. Clinical outcomes consisted of Numerous Rating Scale of pain, Foot and Ankle Outcome Score, 36-item Short Form Survey and complications and re-operations. Results Fifty-five percent of the patients returned to their preoperative type of sport at a median time of 23 weeks post-operatively (IQR 9.0–49), 95% of the patients returned to any type and level sport at a median time of 12 weeks post-operatively (IQR 4.0–39), 18% returned to their preoperative performance level at a median time of 25 weeks post-operatively (IQR 8.0–46) and 5% returned to improved performance postoperatively at 28 weeks postoperatively (one patient). Median NRS in rest was 1.0 (IQR 0.0–4.0), 2.0 during walking (IQR 0.0–5.3) during walking, 3.0 during running (IQR 1.0–8.0) and 2.0 during stair-climbing (IQR 0.0–4.5). The summarized FAOS score was 62 (IQR 50–90). The median SF-36 PCSS and the MCSS were 46 (IQR 41–54) and 55 (IQR 49–58), respectively. No complications and one re-do subtalar arthroscopy were reported. Conclusion Six out of ten patients with sinus tarsi syndrome returned to their pre-injury type of sport after being treated with a subtalar arthroscopy. Subtalar arthroscopy yields effective outcomes at long-term follow-up concerning patient-reported outcome measures in athletic population, with favorable return to sport level, return to sport time, clinical outcomes and safety outcome measures. Level of evidence IV.

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Sinus Tarsi Volume Changes with Hindfoot Position on Weight-Bearing CT Scan

Foot & Ankle Orthopaedics ◽

10.1177/2473011417s000207 ◽

2017 ◽

Vol 2 (3) ◽

pp. 2473011417S0002

Author(s):

Michael Hull ◽

Tyler Rutherford ◽

Clifford Jeng ◽

John T. Campbell ◽

Rebecca Cerrato

Keyword(s):

Critical Angle ◽

Clinical Symptoms ◽

Weight Bearing ◽

Lateral Process ◽

Sinus Tarsi ◽

Straight Line ◽

Sinus Tarsi Syndrome ◽

Significant Difference ◽

The Mean ◽

Varus Position

Category: Basic Sciences/Biologics, Hindfoot Introduction/Purpose: Sinus Tarsi syndrome is a frequent cause of anterolateral foot pain following injury. Chronic lateral subtalar pain, often referred to as “Sinus Tarsi Syndrome”, is commonly reported to occur following trauma. One hypothetical epidemiological predisposing factor for sinus tarsi syndrome is flatfoot deformity with valgus hind foot alignment. Common conservative treatment includes medial heel posting to attempt to widen the sinus tarsi space and alleviate synovitic pain. Although treatment with operative intervention has been reported, no data exists to evaluate if hindfoot realignment functionally opens the sinus tarsi volume. Methods: Weight-bearing Computed Tomography (CT) scans were obtained in 5 healthy volunteers standing at rest on slanted platforms, 25 degree valgus and 25 degree varus. The volume of the sinus tarsi was measured on each scan. Cross sectional area of the sinus tarsi was measured in 3.6 mm slices from the most lateral fully enclosed image to the most lateral aspect of the middle facet of the subtalar joint. Area measurements were multiplied by cut depth (3.6 mm) and summed. Critical angle distance was measured as a straight line from the most lateral point of the lateral process of the talus to the base of the critical angle of Gissane. Subfibular distance was then measured from the most distal tip of the fibula in a straight line to the nearest point of the lateral calcaneal wall. Data were compared using a one way ANOVA and Tukey’s multiple comparison test. Results: The mean sinus tarsi volume in the valgus position was 325.1 mm3 (±88) and 313.3 (±71) for the left and right foot, respectively. In the varus position, the mean sinus tarsi volume increased to 646.8 mm3 (±169) and 599 mm3 (±203). There was a significant difference between the varus and valgus position for both feet (left p<0.01 / right p<0.05). The critical angle distance increased from 28.1 mm (±7.5) to 91.3 mm (±26) for the left foot and 26.3 mm (±7.6) to 87 mm (±27.9) for the right foot when realigned to the varus position (p<0.0001). There was not a significant increase in the sub fibular distance when repositioned from valgus to varus (p=0.06 / p=0.35). Conclusion: This study confirms that moving from a valgus to a varus position significantly increases the volume of the sinus tarsi as well as significantly increases the distance from the lateral process of the talus to the calcaneal angle of Gissane. Interestingly, subfibular distance did not significantly increase, although this may reach significance with increased samples. With confirmation that adjusting hindfoot positioning impacts lateral osseous impingement, future studies are warranted to correlate these findings with clinical symptoms.

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