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Sinus tarsi syndrome, described by O'Connor in 1958 and Brown in 1960, is a clinical finding often seen after an accident, consisting of a painful reaction to pressure on the sinus tarsi. This syndrome has also been described in dancers, volleyball and basketball players, overweight individuals, and patients with foot deformities (flatfoot). We looked for mechanical and functional macroscopic structures in the canalis and sinus tarsi that can be associated with sinus tarsi syndrome in order to deduce therapeutic consequences.We found a complex fibrous layer in the sinus and canalis tarsi that forms slips around the synovial sheats of the extensor tendons under the inferior extensor retinaculum. Both limbs run deep to the base of the sinus and canalis tarsi. The lateral band inserts into the sinus tarsi at the calcaneus, while the medial band inserts at the canalis tarsi at the talus and calcaneus. Instead of the term "interosseous ligaments," we recommend referring to the "fundiform ligament" with one lateral and one medial band.Regarding function, one can assume that the medial band of these fundiform ligaments controls the talus at eversion and inversion together with the well-vasculated and well-innervated interarticular fat pads in the sinus and canalis tarsi. While contracting the long extensor muscles of the toes, the ligament forms a control mechanism for the longitudinal arch of the foot in the moving phase.A question is how variations in vascularization or disorders in innervation will alter the turgor of the pads of fat tissue. That is, such alterations would influence the distribution of synovia in the neighboring joints as well as the tension of the involved ligaments.
Sinus tarsi syndrome was also described by Duchenne in the late 1860's. (It wasn't called that but he described pain in that location being relate to the position of the STJ.) It's always good to look at the anatomy, but you have to look at function and forces as well. In my opinion sinus tarsi pain is the result of end of range of motion of the joint resisting high external pronation moments.
I use to Dx more Sinus Tarsi Syndromes then I do now. When I began performing Ankle Scopes about 10 years ago I started to appreciate how extensive ankle synovitis can be. I now think that some of the Sinus Tarsi I use to Dx may have in fact been ankle synovitis in the anteriolateral area.
I have evacuated Sinus Tarsi's a few times. Difficult to say what the pathology might have been but they all did well! I would imagine when you remove all the contents of the Sinus Tarsi (nerve included) you'll most likely remove whatever was symptomatic.
Steve
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DrSArbes
Fellow American College of Foot & Ankle Surgeons
Board Certified Foot & Ankle Surgery, ABPS
Green Bay, Wisconsin, USA
Here's the article that I submitted for publication to JAPMA 20 years ago where I first described the mechanical association between large magnitudes of subtalar joint pronation moments and sinus tarsi syndrome (Kirby KA: Rotational equilibrium across the subtalar joint axis. JAPMA, 79: 1-14, 1989).
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Sincerely,
Kevin
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Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College
Subtalar arthroscopy for sinus tarsi syndrome: arthroscopic findings and clinical outcomes of 33 consecutive cases.
Lee KB, Bai LB, Song EK, Jung ST, Kong IK. Arthroscopy. 2008 Oct;24(10):1130-4.
Quote:
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.
What actualy hurts in sinus tarsi syndrome
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