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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
References
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