Staged surgical management of sinus tarsi syndrome: our experience of 273 cases.

Abstract

The sinus tarsi syndrome (STS) is a common foot and ankle disease with controversial pathogenesis and treatment procedures. This long-term study aimed to analyze the effect of a staged surgical strategy for STS. Clinical data were retrospectively analyzed in 273 STS patients [129 men and 144 women; mean age: 36 years (10-60 years)] treated between 2006 and 2016. The 89 patients underwent different surgeries, including sinus tarsal debridement, subtalar joint stabilization, sinus tarsal denervation, tarsal coalition resection, or subtalar arthrodesis. The patients' American Orthopedic Foot & Ankle Society (AOFAS) ankle-hindfoot scores, visual analogue scale (VAS) scores for pain during daily activities, and 36-item short-form health survey (SF-36) scores at the first visit and latest follow-up were assessed by paired T-test. The 89 patients who failed conservative treatments first underwent tarsal sinus soft tissue debridement, with 52 patients remaining in remission after 2 years. The other 37 patients with relapse underwent further surgeries. Five of the 19 patients with subtalar instability were cured following ligament reconstruction surgery. Two of the four patients with severe neurological signs recovered after nerve release surgery. Five of the 10 patients with tarsal coalition were cured by resection of the talocalcaneal bridge. A total of 21 patients failed their second operations due to peroneal spasm, and were eventually successfully treated by subtalar arthrodesis. In addition, subtalar arthrodesis was directly performed in the remaining four patients with peroneal spastic flatfoot. After the final operations, all patients achieved satisfactory results. The AOFAS ankle-hindfoot scores increased from 34.83±12.21 preoperatively to 85.52±7.07 postoperatively (t=-24.62, P<0.01), the VAS scores decreased from 8.14±1.52 to 2.14±1.00 (t=24.65, P<0.01), and the SF-36 scores increased from 36.58±11.36 to 86.22±9.17 (t=-28.13, P<0.01). In this study, we observed that 67% (184/273) of patients with STS need a staged surgical management. According to the etiology, symptoms, and severity, soft tissue surgery is the first choice. However, simple soft tissue surgeries may fail to achieve long-term results. Once the symptoms recur and become difficult to cure, the staged surgical strategy for STS we proposed can be the best choice to achieve long-term results.