Sinus tarsi syndrome | |
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Other names | STS |
A medical diagram of the foot bones, with the sinus tarsi labeled (upper right; next to Tarsus label) | |
Specialty | Orthopedics, podiatry |
Symptoms | Pain or tenderness in the sinus tarsi |
Causes | Ankle sprain; pronation; flat foot; excessive physical activity; PTTD |
Diagnostic method | Physical examination |
Treatment | Physical therapy, orthotics, anti-inflammatories, steroids |
Sinus tarsi syndrome is the clinical disorder of pain and tenderness in the sinus tarsi, which is a lateral tunnel in the foot at the junction of the hindfoot and the midfoot, between the ankle and the heel. [1] [2] Most of the time, sinus tarsi syndrome onsets after ankle sprains, however there can be other causes. [3] There are a variety of treatments, divided into conservative treatments such as physical and orthotic therapy, and more invasive ones such as cortisone injections. [4] The condition is somewhat poorly understood and is subject to heavy debate in the medical community. [5]
Sinus tarsi syndrome can have a variety of causes. The most common is an inversion (rolling out) ankle sprain, which makes up 70-80% of cases, followed by pronation of the foot, which is responsible for about 20-30% of cases. [3] More rarely, excessive physical activity and other forms of foot trauma/chronic ankle injury are thought to be the cause. [1] [6]
In the case of posterior tibial tendon dysfunction causing flatfoot, sinus tarsi syndrome can also develop due to the disruption in the entire structure of the foot. [4]
The condition is also thought to be caused by ankle/subtalar joint instability causing inflammation in the area. [7]
Sinus tarsi syndrome is characterized by pain, tenderness, and instability/aggravation of the pain when walking on uneven surfaces or during weight-bearing activity. The pain will be also aggravated by inversion (turning in) and eversion (turning out). Looseness of the ankle and foot joints can also occur. [3] There is also often the presence of ligament tears, arthrofibrosis, ganglion cysts, or degeneration of the joints. Occasionally, peroneal spasms, valgus hindfoot, and limited varus motion can also be present. [8]
X-ray can show some impingement in the sinus tarsi area. [4] Other diagnostic tests include: bone scans, CT scans, and MRI evaluation. Doctors may inject local anesthetic to localize the problem to the sinus tarsi. [3] Radiopharmaceuticals can also be used to identify inflammation. [1] Ankle arthroscopy may also be used to locate damaged tissue. Diagnosis is often a process of elimination as sinus tarsi syndrome is rarely a definitive disorder. [3]
Conservative (non-surgical) treatments are often considered first. Possible treatments include: [3] [4] [9]
However, while conservative treatments are often effect, resistant cases may require more invasive treatments such as: [1] [3] [4] [9]
These forms of treatment, while being invasive and expensive, are known to be very effective.
Surgical treatments are very rare and reserved for highly resistant cases. Surgery can be open (via an incision) or closed (via arthroscopy). [3] In cases of flatfoot, sinus tarsi syndrome is complicated by the collapse of the arches. In these cases, surgery includes debridement (cleaning out) of the sinus tarsi and possible reconstruction of the foot. Surgery can also include debridement of bone spurs as well. [4]
In cases where joint insufficiency causes the syndrome, surgery is often very effective. [7]
If treated, sinus tarsi syndrome has an excellent prognosis. [10] Full recovery is to be expected, though some patients will need rehabilitation. [1] However, relapse can occasionally occur, especially if only conservative treatments are undergone. [8] Sinus tarsi syndrome can be misdiagnosed as a chronic ankle sprain. Untreated sinus tarsi syndrome can develop into chronic ankle pain and disability. [9]
Sinus tarsi syndrome was first studied by Dr. Denis O'Connor in 1957. O'Connor claimed conservative treatment was ineffective and surgery was the only effective option, describing a surgery in which the surgeon resects the superficial ligamentous floor and cleans out the fat pad. O'Connor claimed all 14 patients this surgery was performed on reported relief of their symptoms. While there is not a lot of consensus in the medical community (and the disorder continues to be understudied), other treatment options, including conservative treatments, have been to proven to be viable in the time since. [5]
Since its first description, the causes of the syndrome have also been in dispute. In 1960, Brown proposed that herniation caused the pain and discomfort associated with the syndrome. In 1981, Taillard et al describes ligament tearing as a cause. Further on, Schwarzenbach et al described scarring around the veins to be the source of pain. [11]
The ankle, or the talocrural region, or the jumping bone (informal) is the area where the foot and the leg meet. The ankle includes three joints: the ankle joint proper or talocrural joint, the subtalar joint, and the inferior tibiofibular joint. The movements produced at this joint are dorsiflexion and plantarflexion of the foot. In common usage, the term ankle refers exclusively to the ankle region. In medical terminology, "ankle" can refer broadly to the region or specifically to the talocrural joint.
A sprain is a soft tissue injury of the ligaments within a joint, often caused by a sudden movement abruptly forcing the joint to exceed its functional range of motion. Ligaments are tough, inelastic fibers made of collagen that connect two or more bones to form a joint and are important for joint stability and proprioception, which is the body's sense of limb position and movement. Sprains may be mild, moderate, or severe, with the latter two classes involving some degree of tearing of the ligament. Sprains can occur at any joint but most commonly occur in the ankle, knee, or wrist. An equivalent injury to a muscle or tendon is known as a strain.
Clubfoot is a congenital or acquired defect where one or both feet are rotated inward and downward. Congenital clubfoot is the most common congenital malformation of the foot with an incidence of 1 per 1000 births. In approximately 50% of cases, clubfoot affects both feet, but it can present unilaterally causing one leg or foot to be shorter than the other. Most of the time, it is not associated with other problems. Without appropriate treatment, the foot deformity will persist and lead to pain and impaired ability to walk, which can have a dramatic impact on the quality of life.
Plantar fasciitis or plantar heel pain is a disorder of the plantar fascia, which is the connective tissue which supports the arch of the foot. It results in pain in the heel and bottom of the foot that is usually most severe with the first steps of the day or following a period of rest. Pain is also frequently brought on by bending the foot and toes up towards the shin. The pain typically comes on gradually, and it affects both feet in about one-third of cases.
Achilles tendinitis, also known as achilles tendinopathy, occurs when the Achilles tendon, found at the back of the ankle, becomes sore. Achilles tendinopathy is accompanied by alterations in the tendon's structure and mechanical properties. The most common symptoms are pain and swelling around the affected tendon. The pain is typically worse at the start of exercise and decreases thereafter. Stiffness of the ankle may also be present. Onset is generally gradual.
Flat feet, also called pes planus or fallen arches, is a postural deformity in which the arches of the foot collapse, with the entire sole of the foot coming into complete or near-complete contact with the ground. Sometimes children are born with flat feet (congenital). There is a functional relationship between the structure of the arch of the foot and the biomechanics of the lower leg. The arch provides an elastic, springy connection between the forefoot and the hind foot so that a majority of the forces incurred during weight bearing on the foot can be dissipated before the force reaches the long bones of the leg and thigh.
A joint dislocation, also called luxation, occurs when there is an abnormal separation in the joint, where two or more bones meet. A partial dislocation is referred to as a subluxation. Dislocations are often caused by sudden trauma on the joint like an impact or fall. A joint dislocation can cause damage to the surrounding ligaments, tendons, muscles, and nerves. Dislocations can occur in any major joint or minor joint. The most common joint dislocation is a shoulder dislocation.
Chondromalacia patellae is an inflammation of the underside of the patella and softening of the cartilage.
Achilles tendon rupture is when the Achilles tendon, at the back of the ankle, breaks. Symptoms include the sudden onset of sharp pain in the heel. A snapping sound may be heard as the tendon breaks and walking becomes difficult.
Tarsal tunnel syndrome (TTS) is a nerve entrapment syndrome causing a painful foot condition in which the tibial nerve is compressed as it travels through the tarsal tunnel. This tunnel is found along the inner leg behind the medial malleolus. The posterior tibial artery, tibial nerve, and tendons of the tibialis posterior, flexor digitorum longus, and flexor hallucis longus muscles travel in a bundle through the tarsal tunnel. Inside the tunnel, the nerve splits into three segments. One nerve (calcaneal) continues to the heel, the other two continue on to the bottom of the foot. The tarsal tunnel is delineated by bone on the inside and the flexor retinaculum on the outside.
In human anatomy, the subtalar joint, also known as the talocalcaneal joint, is a joint of the foot. It occurs at the meeting point of the talus and the calcaneus.
The calcaneofibular ligament is a narrow, rounded cord, running from the tip of the lateral malleolus of the fibula downward and slightly backward to a tubercle on the lateral surface of the calcaneus. It is part of the lateral collateral ligament, which opposes the hyperinversion of the subtalar joint, as in a common type of ankle sprain.
An accessory navicular bone is an accessory bone of the foot that occasionally develops abnormally in front of the ankle towards the inside of the foot. This bone may be present in approximately 2-21% of the general population and is usually asymptomatic. When it is symptomatic, surgery may be necessary.
Greater trochanteric pain syndrome (GTPS), a form of bursitis, is inflammation of the trochanteric bursa, a part of the hip.
Arthrofibrosis has been described in most joints like knee, hip, ankle, foot joints, shoulder, elbow, wrist, hand joints as well as spinal vertebrae. It can occur after injury or surgery or may arise without an obvious cause. There is excessive scar tissue formation within the joint and/or surrounding soft tissues leading to painful restriction of joint motion that persists despite physical therapy and rehabilitation. The scar tissue may be located inside the knee joint or may involve the soft tissue structures around the knee joint, or both locations.
Foot and ankle surgery is a sub-specialty of orthopedics and podiatry that deals with the treatment, diagnosis and prevention of disorders of the foot and ankle. Orthopaedic surgeons are medically qualified, having been through four years of college, followed by 4 years of medical school or osteopathic medical school to obtain an M.D. or D.O. followed by specialist training as a resident in orthopaedics, and only then do they sub-specialise in foot and ankle surgery. Training for a podiatric foot and ankle surgeon consists of four years of college, four years of podiatric medical school (D.P.M.), 3–4 years of a surgical residency and an optional 1 year fellowship.
Haglund's syndrome is a group of signs and symptoms consisting of Haglund's deformity in combination with retrocalcaneal bursitis. It is often accompanied by Achilles tendinitis.
The sinus tarsi, also known as the talocalcaneal sulcus, is a cylindrical canal in the hindfoot. It has a complex anatomy, with five ligamentous structures and a pad of adipose tissue (fat). The tarsal canal opens up into the sinus tarsi, however, the tarsal canal is a distinct structure.
Mueller–Weiss syndrome, also known as Mueller–Weiss disease, is a rare idiopathic degenerative disease of the adult navicular bone characterized by progressive collapse and fragmentation, leading to mid- and hindfoot pain and deformity. It is most commonly seen in females, ages 40–60. Characteristic imaging shows lateral navicular collapse. This disease had been historically considered to be a form of adult onset osteonecrosis, with blood flow cutoff to the navicular.
Posterior tibial tendon dysfunction is the dysfunction of the posterior tibial tendon. It is a progressive disease that has 4 stages and is the most common cause of adult flatfoot.