J Korean Foot Ankle Soc.  2018 Mar;22(1):16-20. 10.14193/jkfas.2018.22.1.16.

Accessory Talar Facet Impingement due to Accessory Anterolateral Talar Facet Misdiagnosed as Sinus Tarsi Syndrome

• Park JW
• Park CH

• KMID: 2407370
• DOI: http://doi.org/10.14193/jkfas.2018.22.1.16

Abstract

PURPOSE
To evaluate the clinical and radiographic results of surgical treatment for patients with sinus tarsi pain due to accessory talar facet impingement.
MATERIALS AND METHODS
Between July 2013 and July 2015, nine patients who underwent surgery for the accessory talar facet impingement were reviewed. The mean follow-up period was 18.6 months (12~36 months), and the mean age was 33.1 years (19~60 years). Previous trauma history, duration of symptom, and types of surgery were analyzed. The clinical results were evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and visual analogue scale (VAS). Radiographic results were assessed using Meary's angle, calcaneal pitch angle, heel alignment angle, and heel alignment ratio.
RESULTS
All patients had evident trauma history prior to the initial symptom. The mean duration of symptoms was 25.6 months (6~120 months). Four patients received only accessory anterolateral talar facet (AALTF) excision, and four patients received medial sliding calcaneal osteotomy (MSCO). One patient underwent both AALTF excision and MSCO. The AOFAS ankle-hindfoot score was significantly improved from 73 (62~77) preoperatively to 93 (67~100) postoperatively. The VAS score was decreased from 6 (5~7) preoperatively to 1 (0~5) postoperatively. The Meary's angle and calcaneal pitch angle showed no significant difference after surgery. The heel alignment angle and ratio increased from −3.6° (−10°~5°) and 0.22 (−0.15~0.6) preoperatively to 2.8° (1°~5°) and 0.42 (0.3~0.6) postoperatively, respectively.
CONCLUSION
If there is persistent sinus tarsi pain in patients with hindfoot valgus, accessory talar facet impingement caused by AALTF could be considered as a cause of chronic sinus tarsi pain.

Keyword

Ankle; Sinus tarsi; Accessory talar facet impingement; Accessory anterolateral talar facet

MeSH Terms

Ankle
Follow-Up Studies
Foot
Heel
Humans
Osteotomy

Figure

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  Figure 1 A 33-year-old man with pain on sinus tarsi after severe ankle sprain. Magnetic resonance imaging shows cartilage continuity between articular surface of talar facet and focal abutting bone marrow edema (arrows).

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  Figure 2 A) Preoperative single photon emission computed tomography/computed tomography (SPECT/CT) shows diffuse uptake at the calcaneus. (B) SPECT/CT taken 1 year after surgery shows decreased uptake at the calcaneus.

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  Figure 3 Subtalar arthroscopy shows partial tear of the interosseous talocalcaneal ligament (a) and the posterior facet of calcaneus (b).

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  Figure 4 (A) Preoperative hindfoot alignment radiograph shows hindfoot valgus deformity, and (B) hindfoot valgus is corrected after medial sliding calcaneal osteotomy.

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