Subtalar arthrodesis in the treatment of sinus tarsi syndrome with peroneal spasm / 中华骨科杂志

ABSTRACT

Objective:To explore the long-term clinical efficacy of subtalar arthrodesis for treating sinus tarsi syndrome (STS) with peroneal spasm.Methods:Clinical informationof 32 patients with sinus tarsi syndrome complicated with peroneal spasm who were treated by subtalar arthrodesis from January 2006 to December 2016 was retrospectively analysed. There were 19 males and 13 females, aged 29.3±10.9 y (range 13-56 y), and course of disease is 2.1±1.7 y (range 1-10 y). All patients suffered from tarsal sinus pain and intractable peroneal spasm. The aetiology was foot or ankle inversion sprainin 25 patients, lower limb nerve injury in four patients, and ambiguous causes in three patients.The patients were divided into three groups according to their initial symptoms. Group A Patients with simple peroneal spasm underwent tarsal sinus debridement firstly and subtalar joint fusion after symptom recurrence. Group B Patients with peroneal spasm combined with other symptomsunderwent sinus tarsal cleansing and other symptomatic operations, and received subtalar joint fusion after symptoms recurred. Group C Patients with peroneal spastic flat foot were treated withsubtalar joint fusion directly.Preoperative and postoperative American Orthopaedic 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) scoreswere investigated.Results:32 cases were successfully completed operation, following-up 87 (40, 133) months. Group A(14 cases) The patients were treated withsinus tarsi debridement first. But their symptoms recurred in an average of 7.7 months after surgery. Later they received subtalar joint fusion. Group B (15 cases) In addition to tarsal sinus debridement, 3 cases were undergone tarsal coalitions resection, 3 cases were got denervation of tarsal sinus, 6 cases were received subtalar joint stabilization, and 3 cases were released their peroneal tendons. Their symptoms recurred in an average of 6.4 months after surgery, and they eventually were undergone subtalar arthrodesis. Group C (3 cases) Their initial symptoms were severe, manifested as rigid flat feet caused by peroneal tendons spasm, so they directly underwent subtalar joint fusion. The average AOFAS ankle and hindfoot scores for all patients increased from 27.86±10.79 points before treatment to 86.34±7.17 points at the last follow-up after operation ( t=23.505, P<0.05). The VAS scores decreased from 8.00±1.57 points before treatment to 1.91±1.06 points at the last follow-up after operation ( t=18.407, P<0.05). The SF-36 scores increased from 35.84±12.12 points before treatment to 86.20±10.32 points at the last follow-up after operation ( t=24.203, P<0.05). Conclusion:Sinus tarsi syndrome with peroneal spasm due to its complicated etiology and pathogenesis can give priority to sinus tarsal debridement or other symptomatic surgeries. If the symptoms recur, subtalar arthrodesis can be an alternative choice to achieve the long-term effects.