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Sinus Tarsi Syndrome

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Other Names

  • Sinus Tarsi Syndrome (STS)
  • Canalis Tarsi Syndrome

Background

  • This page refers to sinus tarsi syndrome (STS), a syndrome characterized by lateral hindfoot pain at the level of the Sinus Tarsi

History

  • First described by Denis O'Connor in 1958[1]

Epidemiology

  • Most patients present in the 3rd, 4th decade of life (need citation)

Pathophysiology

  • General
    • Overall poorly understood condition and no widely accepted diagnostic criteria
    • Described as clinical entity characterized by persistent anterolateral ankle pain secondary to traumatic injuries to the ankle
    • Due to instability of the subtalar joint due to ligamentous injuries resulting in synovitis, infiltration of fibrotic tissue into the sinus tarsi space
  • Controversy
    • Although generally accepted as a syndrome, some physicians argue that each case of STS can be attributed to a more specific diagnosis
    • For example, Frey et al. performed subtalar arthroscopy on 14 patients with STS, all of whom were given a more specific diagnosis such as a ligament tear post-operatively[2]
  • Canalis tarsi syndrome
    • A severe variant which can include medial hindfoot pain in addition to the typical lateral symptoms

Etiology

  • General
    • Caused by hemorrhage and/or inflammation of the synovial recesses of the sinus tarsi
    • With or without tears of the associated ligaments
    • This leads to synovitis, inflammation, infiltration of fibrotic tissues
  • Causes
    • Trauma is the most common cause following a single or a series of ankle sprains[3]
    • Inflammatory arthritis such as rheumatoid arthritis, gout, or ankylosing arthritis.
    • Flatfoot deformity, tumours and soft tissue impingement have also been implicated

Associated Conditions

Pathoanatomy

Risk Factors

  • Sports
    • Dancers
    • Volleyball
    • Basketball players
  • Systemic
    • Overweight individuals
  • Structural

Differential Diagnosis

Clinical Features

Clinical location of the tarsal sinus[4]
  • History
    • Pain localized to the lateral hindfoot (sinus tarsi region)
    • Worse with walking, supination, adduction
    • Sensation of instability when walking, especially on uneven surfaces[5]
  • Physical Exam: Physical Exam Ankle
    • Inspect for Pes Planus
    • Tenderness over the lateral opening of the tarsal sinus
  • Special Tests

Evaluation

Radiographs

CT

  • Findings
    • Secondary bony changes (earlier than XR)

MRI

  • Imaging modality of choice
    • Lektrakul found high sensitivity with unknown specificity[6]
  • Challenges
    • Oblique course of ligamentous structures in the sinus tarsi makes identifying a specific diagnosis difficult
    • Lee et al: found low agreement between symptomatic MRI and arthroscopy[7]
  • Findings
    • Inflammation
    • Scar tissue formation
    • Ligamentous injuries
  • Ganglion cysts in the region of the sinus tarsi may compress the posterior tibial nerve.

Classification

  • Not applicable

Management

Nonoperative

  • NSAIDS
  • Orthotics/ Inserts
    • Stable shoes
    • Ankle Sleeve
    • Other orthotic
  • Immobilization
  • Cryotherapy

Operative

  • Indications
    • Presence of ganglion cyst
  • Technique
    • Synovectomy
    • Debridement

Rehab and Return to Play

Rehabilitation

  • General recommendations
    • Balance and proprioceptive training
    • Muscle strengthening exercises

Return to Play/ Work

  • Needs to be updated

Complications and Prognosis

Prognosis

  • Needs to be updated

Complications

  • Long term
    • Instability of the subtalar joint due to ligamentous injuries that result in synovitis
    • Scar tissue formation in the sinus tarsi.

See Also

References

  1. ↑ O'CONNOR, D. "Sinus tarsi syndrome. Clinical entity." J. Bone Joint Surg. 40 (1958): 720.
  2. ↑ Frey, Carol, Keith S. Feder, and Christopher DiGiovanni. "Arthroscopic evaluation of the subtalar joint: does sinus tarsi syndrome exist?." Foot & ankle international 20.3 (1999): 185-191.
  3. ↑ Budny A. Subtalor joint instability: Current clinical concepts. Clin Pod Med Surg. 2004;21:449-460.
  4. ↑ Helgeson, Kevin. “Examination and Intervention for Sinus Tarsi Syndrome.” North American Journal of Sports Physical Therapy: NAJSPT, vol. 4, no. 1, Feb. 2009, pp. 29–37.
  5. ↑ Taillard, Willy, et al. "The sinus tarsi syndrome." International orthopaedics 5.2 (1981): 117-130.
  6. ↑ Lektrakul, Nittaya, et al. "Tarsal sinus: arthrographic, MR imaging, MR arthrographic, and pathologic findings in cadavers and retrospective study data in patients with sinus tarsi syndrome." Radiology 219.3 (2001): 802-810.
  7. ↑ Lee, Keun-Bae, et al. "Efficacy of MRI versus arthroscopy for evaluation of sinus tarsi syndrome." Foot & ankle international 29.11 (2008): 1111-1116.
Created by:
John Kiel on 23 September 2021 13:29:14
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Last edited:
3 October 2022 23:53:41
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