Sinus tarsi syndrome: primary classification system of

etiology and pathogenesis

Xu Xiang-yang, Yang Chong-lin, Zhu Yuan, Li Xing-chen,

Ge Wen-tao, Liu Jin-hao, Wang Bi-bo

Foot Ankle Surgery Department

Shanghai Ruijin Hospital,

Shanghai Jiaotong University School of Medicine, China

My disclosure is in the

Final AOFAS Program Book.

I have no potential conflicts with

this presentation.

Introduction

Sinus tarsi syndrome may be connected with subtalar mild instability, ligament injury, arthrofibrosis or joint denervation.

So far, there was no relatively systematic classification for its pathogenesis,

Although many surgeons had tried to find some suitable treatments,

such as subtalar debridement and subtalar arthrodesis.

These methods may be only symptomatic treatments without definite indications and results, and the prognosis of the disease could not be well judged.

Methods

From Jan. 2006 to Dec. 2011

67 patients suffering from STS

We analysised the etiological factors of all cases in order to

categorize into following four situations:

1.subtalar inflammation

2.subtalar instability

3.peroneal spasm

4.local nervous disorders

Type I: mild

IA. simple synovitis

IB. simple subtalar instability

IC. simple nervous disorders

Type II: moderate

IIA. synovitis and nervous disorders

IIB. synovitis and subtalar instability

IIC. synovitis and peroneal spasm

Type III: severe

IIIA. synovitis, subtalar instability

and peroneal spasm

IIIB. synovitis, nervous disorders

and peroneal spasm

IIIC. synovitis, subtalar instability

and nervous disorders

Type IV: profound

synovitis subtalar instability

nervous disorders

peroneal spasm

Pathological Mechanism: Combined different situations into concrete classifications

Results

Case

Male , 24y/o, policeman

Spastic pain in left foot for 3 years

Deny the history of ankle sprain.

The peroneal spasm started first time when he is sleeping suddenly

Cramp again and again

Severe pain and peroneal spasm when invert his ankle

Lidocaine injection into tarsal sinus had not effect on changing the gait in our hospital

The first debridement of sinus tarsal

Joint effusion

Scar tissue proliferation

Excise inflammatory synovium tissue in sinus tarsal

Pain and spasm were relieved shortly

after the surgery.

But three months later, he came back,

complaining of the same symptoms.

The Second Debridement:

* Cut off the branch of superficial peroneal nerve (red

arrow)

* Drilling a hole in the lateral malleolus

* Put the nerve end into the hole (red circle)

However, no more than half year post-op Came back again, suffering from the

very uncomfortable foot

Any passive movement of his foot

trigger severe pain

The previous surgery was failed

Subtalar arthrodesis at last time

Annalysis：

Stability is very important for the nerve irritation

control

Inflammatory stimulation can make the

asymptomatic flatfoot to the peroneal spastic

flatfoot.

We chose appropriate treatments on the basis of different

Types.

• conservative treatments: medication (e.g. NSAIDs) and local lidocaine injection Type I

• The first choice was sinus tarsi debridement under subtalar arthroscopy if conservative methods above were not effective

• And the second choice was selective denervation of the sinus tarsi Type II

• Subtalar arthrodesis was the best and ultimate procedure when debridement and denevation did not work.

Type III Type IV

Conclude

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