Posterior subtalar joint arthrography. A useful tool in the diagnosis of hindfoot disorders.

Obscure hindfoot disorders are often classified under the heading of sinus tarsi syndrome (STS). The diagnosis of STS is based upon subjective symptoms: tenderness over the lateral aperture of the sinus tarsi and hindfoot instability. Arthrography of the posterior subtalar joint is an objective parameter, identifying peri- or intraarticular pathology as the cause of symptoms. In 27 patients with STS, the pathologic arthrographic findings include less-marked microrecesses in the sinus tarsi region, ganglions at the anterior aspect of the subtalar joint, retraction of the joint recesses, a smooth and rounded appearance of the capsule, and a frozen subtalar joint. Through analysis of these films, the appropriate therapeutic approach can be outlined; infiltrations into the sinus tarsi itself, intraarticular corticosteroid injections, or subtalar arthrodesis for resistant cases are the procedures of choice. In the authors' experience, surgical curettage of the sinus tarsi has no place in the treatment of STS.

Tarsal tunnel syndrome: clinical and pathological results.

The tarsal tunnel syndrome is a complex entity. The condition results from a compression of the posterior tibial nerve, either at its terminal or collateral branches, at the tibio-astragalo-calcaneal canal of Richet. A retrospective study of 27 consecutive cases, treated by epi- or perineural neurolysis, illustrates the variability of the clinical picture but fails to confirm the complete and immediate success of the intervention, as reported by the majority of authors. However, the long-term follow-up shows a significant improvement in the terminal latencies of the posterior tibial nerve at 2 years post-surgery. A pathological study of 20 cadaveric feet discloses microscopic anomalies in 22 of the 120 nerve biopsy specimens.

Lisfranc's fracture-dislocations: etiology, radiology, and results of treatment. A review of 20 cases.

Tarsometatarsal fracture-dislocation is an uncommon but severe lesion. Since this diagnosis is over-looked in about 20% of cases, accurate radiographic examination is imperative. In the presence of suggestive clinical signs and negative standard roentgenograms, stress-films in eversion-pronation and inversion-supination are obtained under general anaesthesia. A review of 20 cases shows that plaster cast immobilization without reduction is unsatisfactory, often resulting in Südeck's atrophy and subsequent painful degenerative arthritis. Secondary fusion may be necessary to relieve symptoms. The treatment of choice is anatomic reduction and transfixation with Kirschner wires. The major complication is arterial damage with necrosis of the forefoot. Amputation may be necessary.