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

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.

TL 18075 - Subtalar arthroscopic debridement for treatment of sinus tarsi syndrome

Introduction: Sinus tarsi syndrome (SST) can be understood as a set of conditions that affect this anatomical region and manifest as common signs and symptoms. When the nonsurgical approach fails, subtalar arthroscopic debridement is a viable alternative with high rates of good outcomes. The objective of this study is to report the outcomes of subtalar arthroscopic debridement in 8 patients with SST refractory to conservative treatment. Methods: This is a retrospective study with 8 patients diagnosed with SST who underwent subtalar arthroscopic debridement of the sinus tarsi from January 2015 to January 2017, after 6 months of conservative treatment. All patients filled out an epidemiological questionnaire and underwent functional evaluation using the pain visual analog scale (VAS) and the American Orthopedic Foot and Ankle Society (AOFAS) scale preoperatively and at the final evaluation, after an average of 12 months (6-24 months). Results: All patients presented with intense synovitis in the region. Seven patients had remnants of talocalcaneal ligaments, and 6 had remnants of cervical ligaments. The AOFAS score increased by a mean of 30 points (from 51.75 preoperatively to 82.62 at the final evaluation), and the VAS decreased by a mean of 5 points (from 7.37 preoperatively to 2.12 at the final evaluation); these differences were significant, at p=0.043 and p=0.032, respectively. Six patients described the outcome as excellent, and 2 described it as good. No complications were reported. All patients resumed sports activities after 6 months of follow-up. Conclusion: Subtalar arthroscopic debridement is an effective and safe alternative in the treatment of SST refractory to conservative treatment. Further prospective studies are necessary to prove the outcome of this technique.

Subtalar arthroscopic debridment for the treatment of sinus tarsi syndrome: case series

SUMMARY OBJECTIVE: The objective of this study is to report the results of arthroscopic debridement of the subtalar joint in eight patients with Sinus Tarsi Syndrome (STS) refractory to conservative treatment. METHODS: This is a retrospective study of eight patients with STS who underwent subtalar arthroscopy for debridement of the sinus tarsi between January 2015 and January 2017 after six months of conservative treatment. All patients answered an epidemiological questionnaire and underwent functional evaluation with the Visual Analogue Pain Scale (VAS) and the American Orthopedic Foot and Ankle Society Score (AOFAS) in the preoperative and in the last evaluation (average of 12 months - 6-24 months). RESULTS: All patients showed severe synovitis in the region. Seven patients had remnants of the talocalcaneal ligaments and six of the cervical ligament. AOFAS increased by 30 points on average (51.75 in the preoperative period to 82.62 in the last follow-up) and the VAS decreased on average by 5 points (7.37 preoperatively to 2.12 in the last follow-up). These results were statistically significant with p = 0.043 and p = 0.032 respectively. Six patients described the result as excellent and two as good. No complications were reported. All patients returned to sports after six months of follow-up. CONCLUSION: The arthroscopic debridement of the subtalar joint is an effective and safe alternative in the treatment of STS refractory to conservative treatment. More studies, with a prospective methodology, are necessary to prove the results of this technique.

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

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.