Sinus Tarsi Volume Changes with Hindfoot Positioning on Weight-Bearing CT Scan

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1 Sinus Tarsi Volume Changes with Hindfoot Positioning on Weight-Bearing CT Scan Michael Hull, M.D. Tyler Rutherford, M.S. Rebecca A. Cerrato, M.D. John T. Campbell, M.D. Clifford L. Jeng, M.D.

2 Measuring Visualized Joint Surface in Hallux MTP Arthroscopy NO CONFLICT TO DISCLOSE Our disclosures are in the Final AOFAS Mobile App There are no potential conflicts with this presentation

valgus HFA Conservative treatment Medial heel posting attempts to widen the sinus tarsi

3 Sinus Tarsi Syndrome Chronic lateral subtalar pain, or Sinus Tarsi Syndrome, is commonly reported to be caused secondary to prior trauma Predisposing factors Flatfoot deformity and valgus HFA Conservative treatment Medial heel posting attempts to widen the sinus tarsi space and alleviate synovitic pain. Question: Does changing heel position alter sinus tarsi volume?

4 Methods IRB approved retrospective study using six healthy volunteers Weight-bearing Computed Tomography (CT) scans 25 varus and 25 valgus platforms Bilateral imaging was obtained, resulting in 4 scans per volunteer for a total of 24 scans Statistical Analysis One way ANOVA GraphPad Prism

Sinus Tarsi Volume Saggital imaging Measure cross sectional area of sinus tarsi space Multiplied by the depth between each measurement (0.36 mm).

5 Sinus Tarsi Volume Saggital imaging Measure cross sectional area of sinus tarsi space Multiplied by the depth between each measurement (0.36 mm). Measurements were continued until the most lateral aspect of the middle facet of the subtalar joint was encountered. The sum of these values estimates the sinus tarsi volume. *Volume = Σ (Area*.36mm)

Other Measurements Critical Angle Distance: Saggital imaging Measure distance from most lateral point of the lateral

6 the distance from the most lateral point of the lateral process of the talus measured as a straight line to the base of the critical angle of gissane. Other Measurements Critical Angle Distance: Saggital imaging Measure distance from most lateral point of the lateral process of the talus to the corner of the critical angle of gissane Subfibular Distance: Coronal imaging Measure distance from the most distal point of the fibula to the nearest point of the lateral calcaneal wall

7 Results Sinus Tarsi Volume Valgus Varus Volume (cm3) * Valgus Position Varus *p < Valgus Varus p - value <

8 Results Critical Angle 10 8 Valgus Varus Distance (mm) * 0 Valgus Position Varus *p < Valgus Varus p - value <

9 Results 12 Subfibular Distance 10 Distance (mm) Valgus Varus 2 0 Valgus Position Varus Valgus Varus p-value NS

10 Sinus Tarsi Correlation Critical Angle Correlation Subfibular Distance Correlation Results Inter- and Intra-observer Reliability Interobserver Reliability: Intraobserver Reliability: R - value Sinus Tarsi Volume Critical Distance Subfibular Distance Inter Intra

11 Conclusion Sinus Tarsi Volume INCREASES in varus Distance from the lateral process of the talus to the Critical angle INCREASES in varus Subfibular distance did not significantly change bringing into question the concept of subfibular impingement (with limitations)

12 References 1. Fong DT, Hong Y, Yung PS, and Chan KM. A systematic review on ankle injury and ankle sprain in sports. Sports Med. 2007;37(1): Van Rijn RM, van Os AG, Bernsen RM, Luijsterburg PA, Koes BW, Bierma-Zeinstra SM. What is the clinical court of acute ankle sprains? A systematic literature review Apr;121(4): Klein MA, Spreitzer AM. MR imaging of the tarsal sinus and canal: normal anatomy, pathologic findings, and features of the sinus tarsi syndrome. Radiology Jan;186(1): Schwarzenbach B., Dora C., Lang A., Kissling RO. Blood vessels of the sinus tarsi and the sinus tarsi syndrome. Clin Anat. 1997;10(3): Frey C., Feder KS., DiGiovanni C. Arthroscopic evaluation of the subtalar joint: does sinus tarsi syndrome exist. Foot Ankle Int Mar;20(3): Lee KB., Bai LB., Song EK., Jung ST., Kong IK. Subtalar arthroscopy for sinus Tarsi syndrome: arthroscopic findings and clinical outcomes of 33 consecutive cases. Arthroscopy Oct;24(10): Rab M., Ebmer J., Dellon AL. Innervation of the sinus tarsi and implications for treating anterolateral ankle pain. Ann Plast Surg Nov;47(5): Oloff LM., Schulhofer SD., Bocko AP. Subtalar joint arthroscopy for sinus tarsi syndrome: review of 29 cases. J Foot Ankle Surg May-Jun;40(3): Smith-Bindman R., Lipson J., Marcus R., Kim KP., Mahesh M., Gould R., Berrington de Gonzalez A., Miglioretti DL. Radiation dose associated with common computer topography examinations and the associated lifetime attributable risk of cancer. Arch Intern Med Dec 14;169(22):

pathologic feature of early ankle arthritis.

pathologic feature of early ankle arthritis. Joint space widening may be a paradoxical pathologic Ji-Beom Kim, MD Young Yi, MD Woo-Chun, Lee Seoul Foot & Ankle Center, Dubalo Orthopaedic Clinic. Disclosure NO CONFLICT TO DISCLOSURE Joint space widening