Have you heard of Sinus Tarsi Syndrome?

This is the 3645th article of Da Yi Xiao Hu

There are many syndromes in clinical practice, some of which are familiar to everyone, some are unfamiliar, and even many young doctors are not familiar with them. The tarsal sinus syndrome mentioned today is not uncommon in clinical practice. A while ago, a young college student came to see a doctor because of repeated intermittent pain for two months after a sprained ankle. The patient also took an X-ray at the time of injury, but no obvious fracture was found, so he did not pay much attention to it and just took a simple rest. The pain has been getting better and worse in the past two months, and local swelling has been found on the outside of the instep. The pain is obvious when pressing, and there is pain when walking. He has visited different hospitals many times, but only symptomatic treatment was given. The pain is sometimes light and sometimes heavy, which is very depressing. I carefully examined the body and considered the tarsal sinus syndrome based on the clinical manifestations and the location of the pain. When explaining the condition to the patient, the patient looked confused. What is tarsal sinus syndrome? I have never heard of it. I arranged for him to have an MRI examination, and the results confirmed my diagnosis.

What is the sinus tarsi?

The tarsal sinus is actually an anatomical structure. The talar groove and the calcaneal groove at the junction of the talus and calcaneus form a funnel-shaped tunnel that opens outward. The sinus opening is located in front of and below the lateral malleolus. The walls of the tarsal sinus are irregular, and there are many vascular holes in the bone walls. The sinus cavity is filled with wide and tough talocervical interosseous ligaments and adipose tissue. There are a large number of peripheral nerves in the synovium of the tarsal sinus, which contains a huge neural network. Therefore, it is not only a cavity between the talus and calcaneus joints, but also a source of information for nociception and proprioception during foot and ankle activities. Tarsal sinus nerve damage and proprioceptor dysfunction may be one of the causes of tarsal sinus syndrome.

What is sinus tarsi syndrome?

In 1957, O'Connor first proposed the concept of tarsal sinus syndrome. After the anatomical structure of the tarsal sinus is damaged, the tarsal sinus area will be in chronic pain without relief, which is the tarsal sinus syndrome. This is a diagnosis of chronic pain in the tarsal sinus area of ​​the subtalar joint based on pathological changes such as mild joint instability, ligament tear, joint fibrosis, and joint denervation.

What are the symptoms?

Most cases have a history of ankle sprain, local swelling on the outside of the foot, persistent pain, poor stability of the heel, pain in the front and lower part of the lateral ankle and deep tenderness or pain in the sole of the foot; the pain may worsen when walking, running or bearing weight, and relieved after rest. The symptoms may occur when it is cloudy, rainy or when the weather turns cold; the calf may feel cold and the soles of the toes may feel numb (caused by autonomic dysfunction caused by the diseased tissue).

What causes sinus tarsi syndrome?

The most common cause of tarsal sinus syndrome is ankle inversion sprain accompanied by ankle supination injury. Other possible causes include congenital or acquired foot deformity, local synovitis, local tumors, etc. Traumatic is the most common, with about 70% having a history of ankle trauma (inversion injury). After the injury, the sinus cavity bleeds, ligaments tear, scars form, joint synovial hyperplasia herniates into the sinus cavity, and the surrounding fibrous tissue hyperplasia surrounds or compresses blood vessels, resulting in increased sinus cavity pressure.

Some patients may feel relief after rest. If the symptoms persist for a long time, blockade therapy may be an option: blockade therapy within the tarsal sinus can achieve temporary or long-term effects.

Author: Department of Orthopedics, Tianjin Third Central Hospital

Guo ShuzhangChief Physician