Original Article
Subtalar Arthroscopy for Sinus Tarsi Syndrome: Arthroscopic Findings and Clinical Outcomes of 33 Consecutive Cases

https://doi.org/10.1016/j.arthro.2008.05.007Get rights and content

Purpose: The purposes of this study were to identify the pathologic findings of sinus tarsi syndrome (STS) by subtalar arthroscopy and to evaluate the results of arthroscopic treatments in 33 consecutive cases. Methods: A retrospective review was performed in 31 consecutive patients (33 cases) who underwent subtalar arthroscopic treatment for STS. The mean follow-up duration was 24 months (range, 18 to 36 months). Patients were evaluated by use of arthroscopic findings (recorded on videotapes and photographs) and clinical outcomes, which included visual analog scale and American Orthopaedic Foot and Ankle Society ankle-hindfoot scores. Results: Arthroscopic findings showed partial tear of the interosseous talocalcaneal ligament in 29 cases (88%), synovitis in 18 (55%), partial tear of the cervical ligament in 11 (33%), arthrofibrosis in 8 (24%), and soft-tissue impingement in 7 (21%). The mean visual analog scale score improved from 7.3 points (range, 6 to 9 points) preoperatively to 2.7 points (range, 1 to 4 points) postoperatively (P < .005), and the mean American Orthopaedic Foot and Ankle Society ankle-hindfoot score improved from 43.1 points (range, 21 to 65 points) preoperatively to 86.2 points (range, 72 to 100 points) postoperatively (P < .005). Of the cases, 16 (48%) had an excellent result, 13 (39%) had a good result, and 4 (12%) had a fair result. Conclusions: Subtalar arthroscopy identified pathologies in the subtalar joint in patients with STS and showed that treatment of these pathologies led to improved function. Level of Evidence: Level IV, therapeutic case series.

Section snippets

Methods

A retrospective review was performed on 53 cases in 50 consecutive STS patients who underwent subtalar arthroscopy between November 2004 and July 2006. To avoid confusion, we excluded 19 patients (20 cases) with fractures around the sinus tarsi (calcaneal fracture, talus fracture, lateral malleolar fracture, and Lisfranc fracture) and/or who underwent additional procedures for combined lesions of the foot and ankle (ankle lateral ligament reconstruction, arthroscopic microfracture for

Results

At arthroscopy, pathologic findings were observed in all 33 cases. In descending order, a partial tear of the ITCL was observed in 29 cases (88%), synovitis in 18 (55%), partial tear of the CL in 11 (33%), arthrofibrosis in 8 (24%), and soft-tissue impingement in 7 (21%) (Table 1 and Fig 1). Of the 33 cases, 28 had combined pathology; two pathologies in 19 cases, three in 7, and four in 2. Of the 29 cases with an ITCL partial tear, 2 had no other pathologic findings. In the remaining 27,

Discussion

All 31 patients enrolled in this study had a preoperative diagnosis of STS. However, in the orthopaedic literature, STS is a vague term that is used to describe clinical entities with causes ranging from traumatic sprains to soft-tissue masses, and thus we suggest that its replacement by some more accurate diagnosis is overdue.14 However, the complex anatomy of the subtalar joint makes accurate diagnosis difficult by radiologic and arthroscopic examinations.1, 8, 12, 13 Lektrakul et al.11

Conclusions

Subtalar arthroscopy identified pathologies in the subtalar joint in patients with STS and showed that treatment of these pathologies led to improved function.

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    Citation Excerpt :

    Brown reports a surgical procedure involving open evacuation of the sinus tarsi, resulting in complete/marked pain relief in 90% of patients [3]. In more recent times, subtalar arthroscopy with synovectomy and removal of fat pad has been investigated [3,5,16,19,23,24,29,30,33,34,42]. All articles investigating this approach report excellent/good results in almost all patients, along with improvements in both visual analogue scale and American Orthopaedic Foot and Ankle score ratings.

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The authors report no conflict of interest.

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