SINUS TARSI SYNDROME


Sagittal T1-weighted and fat suppressed fast spin-echo T2-weighted images through the sinus tarsi show subcortical cysts and marrow edema in the inferior lateral process of the talus, consistent with lateral hindfoot impingement. The sinus tarsi is narrowed due to the alteration of talocalcaneal alignment, with fibrosis occupying the sinus. The tarsal tunnel is a fibro-osseous channel located posteriorly and inferiorly to the medial malleolus with a roof formed by the flexor retinaculum. The tarsal tunnel can be subdivided into an upper tibiotalar tunnel at the level of the ankle joint and lower talocalcaneal tunnel in the hindfoot, the latter considered a true anatomic tarsal tunnel .

ITCL thickness or width showed no significant difference between STI and control groups. According to our results, ITCL thickness and width in the control group were 2.08 mm and 2.85 mm, digital crossword clue respectively. ITCL thickness of this study was similar to the thickness reported in previous studies. However, ITCL width of this study was much narrower than previously reported.

69 year-old male with trauma several years ago, lateral hindfoot pain. Sagittal and coronal fat-suppressed fast spin-echo T2-weighted images show thickening and mild increased signal in the interosseous talocalcaneal ligament , consistent with chronic sprain. A sagittal T1-weighted image demonstrates hypointense fibrosis and edema occupying much of the sinus tarsi.

As the PTT dysfunction progresses, flexible flat foot deformity is followed by a fixed flat foot deformity. Chronic ankle pain is a common complaint in orthopedic practice. The etiology of chronic ankle pain includes various pathologies such as impingement syndromes, entrapment neuropathy, and sinus tarsi syndrome.

The interosseous ligament therefore appears to be the most functionally important of the sinus tarsi ligaments, experimentally and clinically. The sinus tarsi is an anatomical space bounded by the talus and calcaneum, the talocalcaneonavicular joint anteriorly and posterior facet of the subtalar joint posteriorly. It is medially continuous with the much narrower tarsal canal. The sinus tarsi contains the cervical ligament and the three roots of the inferior extensor retinaculum. The tarsal canal contains the interosseous talocalcaneal ligament and the deep and intermediate roots of the inferior extensor retinaculum.

In 10 cases with both STI and LAI, the Broström procedure was performed in addition to the subtalar reconstruction procedure. Debridement and synovectomy were performed for all patients with synovitis. Two ankles had osteochondral lesion of the talus which was treated by arthroscopic debridement and microfracture. Lateral sliding calcaneal osteotomy was performed for one ankle with cavovarus deformity. The subtalar joint may have increased translation mobility if the interosseous and cervical ligaments are disrupted, but this is not always the case. There can also be loss of normal striations owing to edema and hemorrhage.

ITCL, CL, and IER were successfully visualized and characterized in three planes at 100% in the control group, supporting the previous report using 3D proton density MRI . Unlike previous reports, our results suggest that ITCL and CL may not be major stabilizers. Instead, ACL might play a more important role in maintaining the stability of the subtalar joint.

A more serious cause of sinus tarsi syndrome is posterior tibial tendon dysfunction and spring ligament tears which frequently lead to the syndrome. Lisfranc joint complex spans the first through fifth tarsometatarsal joints and provides stability to the midfoot and forefoot. The medial cuneiform and first metatarsal bone form an independent medial tarsometatarsal joint. The second and third metatarsal bones and intermediate and lateral cuneiform bones form the intermediate tarsometatarsal joint, which may communicate with the intercuneiform and cuneonavicular joints of the midfoot. The base of the fourth and fifth metatarsal bones and the distal aspect of the cuboid form the lateral tarsometatarsal joint. The plantar Lisfranc ligament is also critical for stability, it has two bundles extending from the medial cuneiform to the bases of the second and third metatarsals .

Recently, Li SY et al. have designated it a posterior capsular ligament because it is found behind the posterior capsule . The ACL has been described as a thick flat ligament connecting the anterior border of the posterior talocalcaneal facet vertically. Results from cadaver studies have shown the presence of ACL in 78–95% of specimens . To the best of our knowledge, ACL has not been previously described in radiologic literature. Return to play criteria is based on the athlete’s ability to move in all directions and at appropriate speeds.

The clinician needs to insure that the athlete is not using excessive compensatory motions at the rearfoot or hip to maintain a single leg standing position. The test is performed with the athlete in supine with the ankle in 10 degrees of dorsiflexion to keep the talocrural joint in a stable position. The fore-foot is first stabilized by the examiners hand, while an inversion and internal rotational force is applied to the calcaneus. The examiner assesses for an excessive medial shift of the calcaneus and a reproduction of the athlete’s complaint of instability and symptoms.