J Korean Foot Ankle Soc.  2024 Jun;28(2):60-67. 10.14193/jkfas.2024.28.2.60.

Various Pathologic Conditions of Sinus Tarsi Syndrome Assessed by Imaging and Arthroscopic Findings

• Park JJ
• Cho SJ
• Jo SH
• Park CH

• KMID: 2556555
• DOI: http://doi.org/10.14193/jkfas.2024.28.2.60

Abstract

Purpose
Sinus tarsi syndrome (STS) is caused by various pathologies. However, the exact etiology of STS remains controversial. This study evaluated the imaging and arthroscopic findings of patients who underwent surgical treatment after conservative treatment for STS failed.
Materials and Methods
Between December 2014 and August 2018, 20 patients (21 cases) who underwent surgical treatment for STS were included in the study. The clinical results were analyzed using the visual analog scale (VAS) and the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot functional scale. The radiographic results were analyzed using Meary’s angle, calcaneal pitch angle, and hindfoot alignment angle. The pathologic conditions of sinus tarsi were confirmed by magnetic resonance imaging (MRI) and subtalar arthroscopy. Synovitis, bone edema, and accessory anterolateral talar facet (AALTF) were evaluated on MRI. Synovial thickening, cartilage damage, interosseous talocalcaneal ligament (ITCL) and cervical ligament rupture, soft tissue impingement, AALTF, and accessory talar facet impingement (ATFI) were evaluated by subtalar arthroscopy.
Results
The mean duration of symptoms was 28.7 months (4~120). All patients showed significant improvement in the VAS and AOFAS ankle-hindfoot scale. Significant improvements in hindfoot alignment angle and Meary’s angle postoperatively were noted in patients who underwent medial displacement calcaneal osteotomy. MRI confirmed synovitis in all patients, AALTF in 19 cases (90.5%), and ATFI with bone edema in seven cases (33.3%). In subtalar arthroscopy, pathologic conditions were observed in the following order: synovitis in 21 cases (100%), AALTF in 20 cases (95.2%), ITCL partial rupture in nine cases (42.9%), and soft tissue impingement in seven cases (33.3%). All cases had two or more pathological conditions, and 15 (71.4%) had three or more.
Conclusion
In cases of STS that do not respond to conservative treatment, a comprehensive examination of the lesions of the tarsal sinus and lesions around the subtalar joint is essential.

Keyword

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

Figure

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  Figure 1 Bone marrow edema on calcaneus is observed around the AALTF (arrow) on the T2-weighted image. AALTF: accessory anterolateral talar facet.

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  Figure 2 Arthroscopy reveals the AALTF (arrow) projecting anteriorly from the posterior articular surface of the talus and is covered by cartilage. The asterisk and arrowhead mark the posterior articular surfaces of the talus and calcaneus, respectively. AALTF: accessory anterolateral talar facet.

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  Figure 3 On arthroscopy, synovitis and scarring are observed within the sinus tarsi. The asterisk and arrow mark the posterior articular surfaces of the talus and the AALTF, respectively. AALTF: accessory anterolateral talar facet.

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  Figure 4 Arthroscopy reveals the injured cartilage (arrowhead) covering the AALTF. The asterisk and arrow mark the posterior articular surfaces of the talus and the AALTF, respectively. AALTF: accessory anterolateral talar facet.

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  Figure 5 Arthroscopy reveals a partial tear of the talocalcaneal interosseous ligament (arrowhead) within the sinus tarsi. The asterisk and arrow mark the posterior articular surfaces of the talus and the AALTF, respectively. AALTF: accessory anterolateral talar facet.

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