Traumatic neuroma of the branches of the deep peroneal nerve that innervate the sinus tarsi can be the source of recalcitrant lateral ankle pain. That these nerves can be the source of the pain can be demonstrated by nerve blocks, and this pain can be surgically treated by resection of the appropriate branch of the deep peroneal nerve. This article documents the clinical results of this approach in 13 patients with sinus tarsi syndrome. At a minimum of 6 months postoperatively, 10 patients (77%) were completely pain-free, wore normal shoes, and had returned to work. Two patients (15%) had a small degree of residual pain but resumed usual activities and wore normal footwear. One patient had some pain relief but could not resume usual activities. We conclude that denervation of the sinus tarsi can relieve recalcitrant pain emanating from the sinus tarsi. This approach may reduce the need for subtalar fusion or evacuation procedures, including arthroereisis, thus avoiding their potential complications. Moreover, sinus tarsi denervation may allow the continued use of an arthroereisis implant in the presence of satisfactory objective findings, despite the subjective presence of postoperative pain. (J Am Podiatr Med Assoc 95(2): 108–113, 2005)
Background: Sinus tarsi syndrome is characterized by permanent pain on the anterolateral side of the ankle. This pain occurs due to chronic inflammation, characterized by fibrotic tissue remnants and synovitis accumulation after repeated traumatic injuries. Few studies have documented the outcome of injection treatments for sinus tarsi syndrome. We sought to determine the effects of corticosteroid and local anesthetic, platelet-rich plasma, and ozone injection on the sinus tarsi syndrome.
Methods: Sixty patients diagnosed with sinus tarsi syndrome were randomly divided into three groups. Patients in the first group received corticosteroid and local anesthetic, patients in the second group received platelet-rich plasma, and patients in the third group were given ozone injections. Outcome measures were Visual Analog Scale (VAS), American Orthopedic Foot and Ankle Society Ankle-Hindfoot Scale (AOFAS), Foot Function Index (FFI), and Foot-Ankle Outcome Score (FAOS). Outcome measures were evaluated by comparing pre-intervention and post-injection 1-month, 3-month, and 6-month follow-ups.
Results: At the end of the 1st month, third month, and sixth month after injection, significant improvements were observed in all three groups compared to the baseline (p < .001 for all comparisons). In the 1st and third months, the improvements in AOFAS scores were similar in Groups 1 and 3; those in Group 2 were lower (p = .001 and p = .004, respectively). In the 1st month, the improvements in FAOS scores were similar in Groups 2 and 3; those in Group 1 were higher (p < .001). During the 6-month follow-up period, there was no statistically significant difference in VAS and FFI results between all three groups (p > .05).
Conclusions: Corticosteroid and local anesthetic or platelet-rich plasma or ozone injections could provide clinically significant functional improvement for at least six months in patients with sinus tarsi syndrome.
The foot is the foundation of the body. The stability of the osseous hindfoot structure is crucial in bipedal locomotion. The subtalar joint is responsible for conversion of the rotatory forces of the lower extremities and dictates the movements of the midtarsal joints and the forefoot. In a hyperpronated foot, excessive abnormal pronation results in partial to full obliteration of the sinus tarsi. The hypothesis is that the HyProCure device will prevent obliteration of the sinus tarsi, thereby stabilizing the subtalar joint complex and eliminating the excessive forces to the proximal and distal musculoskeletal system that occur with every step.
Five fresh-frozen human foot cadaver specimens that represented pathologic hindfoot and midfoot instability and partial to full obliteration of the sinus tarsi were axially compressed to 2,000 N and internally rotated by 15° to produce maximum pronation of the subtalar joint using a biaxial materials testing machine. The forces were measured across the posterior and anterior talocalcaneal joint facets before and after placement of the HyProCure stent.
The subtalar joint stabilized after placement of the HyProCure sinus tarsi stent. The mean ± 1 SD forces in the posterior talocalcaneal joint increased from 795.88 ± 106 N to 1,004.86 ± 72.41 N (P < 0.05, two-tailed paired t test). The mean ± SD forces at the anterior talocalcaneal joint decreased from 520.15 ± 127.18 N to 394.56 ± 73.83 N (P < 0.05), shifting the contact area posteriorly.
Placement of the HyProCure subtalar stabilization stent in a hyperpronated foot prevents excessive talar subluxation and assists in proper distribution of the axial loads on the subtalar facet joints. (J Am Podiatr Med Assoc 101(5): 390–399, 2011)
The literature reports that 70% of the cases of sinus tarsi syndrome are post-traumatic, following an inversion sprain, and that 30% result from inflammatory disorders, such as rheumatoid arthritis, ankylosing spondylitis, and gouty arthritis. However, in the case presented, talipes equinovarus deformity and sinus tarsi syndrome coexisted. One of the corrective goals in the management of the talipes equinovarus deformity is the realignment of the articulation between the medial plantarly deviated talar head and the anteromedial segment of the calcaneus. The calcaneus must be rotated from a plantarflexed position into a dorsiflexed position. The posterior tubercle will be moved down and in, with the anterior process moved up and out away from the talar head. By correcting the plantarflexed varus attitude of the calcaneus, it is put in a valgus position that often closes down the sinus tarsi upon weightbearing. This compression may result in pain over the lateral aspect of the midfoot with hindfoot instability, as seen in the case presented. As a result of the abnormal anatomical relationship of the talus and calcaneus, the patient developed severe pain in the sinus tarsi. Based on the medical history and present postoperative results, the authors find a long-term sequela of talipes equinovarus deformity to be sinus tarsi syndrome.
Cutaneous horns (cornu cutaneum) are chronic, dense, hyperkeratotic cutaneous lesions resembling the horn of an animal. These lesions are associated with a variety of benign, premalignant, and malignant cutaneous diseases. Cutaneous horns are often found on the upper parts of the body, such as the face, neck, and shoulders. These lesions rarely occur in areas with no sun exposure, such as the feet. We present the case of a 51-year-old man with two cutaneous horns on the lateral aspect of the third digit of the left foot. Treatment consisted of excision of the lesions and application of a full-thickness skin graft from the ipsilateral sinus tarsi.