This usually consists of a combination of non-steroidal inflammatory tablets, and/or panadol, relative rest or avoidance of the painful activities, physical therapy to improve ankle/foot strength and stability, the use of a ankle braces and sometimes the fabrication of orthoses.
If the non-operative treatment has failed, and the patient is comfortable with the fact that the precise cause of the pain may not be certain until after surgery, surgery may become warranted.
The procedure involves either arthroscopic (“key-hole”) or open surgical exploration of the sinus tarsi, and treatment of the pathology found.
The procedure is performed with the patient under a general anesthetic in a sterile operating theatre environment. The patient is given intra-venous antibiotics before the commencement of surgery. A tourniquet is placed on the leg to control bleeding and facilitate visualization at the surgical site.
The incision or incisions are placed over the location of the sinus tarsi (the site of pain). The surgeon will carefully dissect down the level of the bones and the joints between the bones (that is the sinus tarsi proper, between the talus and the calcaneus). Once in the appropriate area, the surgeon will explore all the potential sources of pathology and pain in the sinus tarsi, and address these problems as they are encountered. This is usually a matter of removing the pathologically scarred, thickened and/or impinging tissues.
In most cases this involves the debridement a degenerate and thickened ligament, other scar tissue, thickened synovial tissues or capsule (joint lining), or excision of bone outgrowths.
Once the source of the pain has been confirmed and dealt with, the wounds are closed (usually with dissolving sutures) and the foot and ankle placed in a heavy crepe bandage. Sometimes the foot and ankle have to be placed in a short below knee back slab (half cast).
The patient is discharged home on the day of surgery in most cases.
The patient is usually asked to only partially weight-bear until the first post-operative reviews, 7-10 days post surgery. At this appointment the bandages are removed, the wounds checked and physical therapy organized. The surgeon will monitor your recovery from the procedure with the assistance of the physiotherapist.
Over 90% of patients report a good to excellent outcome following this surgical procedure.
POST-OPERATIVE GUIDELINES FOLLOWING SINUS TARSI SYNDROME SURGERY
These are some general guidelines, however if there are any significant deviations from them you will be informed of this by your surgeon.
If at any stage you experience severe pain (not controlled with the analgesia you were given), fevers, chills, night-sweats, shortness of breath, chest pain, or any symptom about which you are concerned please make immediate contact with your surgeon, your anesthetist, the hospital where your surgery was performed, or (if after hours) your local emergency department (they will be contact your surgeon or manage the problem themselves).
•You will wake up in recovery with your operated leg in a heavy crepe bandage and/or short (below knee) cast, depending upon the findings at surgery
•The bandage and/or cast should be left intact until seen in surgeons rooms for your first post-operative review. Phone the surgeons rooms to confirm the date and time of this appointment if not sure.
•The wound will be closed with dissolving sutures which do not require removal but the wounds must be kept clean and dry until review.
•The nurses will administer pain killers as required
•You will be encouraged to move the knee and hip on the operated side
•When you have recovered from the anesthetic, you will be allowed to mobilize with the assistance of crutches
•You are usually allowed to partially bear weight on the operated side
•The surgeon will see you before you leave and explain the surgical findings and the procedure performed and let you know if you are allowed to weight bear.
From discharge until 2 weeks post surgery
•Although you are allowed to mobilize as indicated above, when not moving around try to keep the ankle above the level of the heart to reduce the amount of swelling and pain.
•You are encouraged to move the operated knee and hip often, and for at least 10 minutes every 3-4 hours during waking hours.
•If your ankle is in a heavy bandage only you will be asked to begin some simple ROM exercises with the bandage in place.
You may notice some bruising appearing in your toes, days to weeks following your surgery. This is bleeding from the operation site that has tracked distally under the influence of gravity and should not cause alarm.
First post-operative review (2 weeks)
•The surgeon will remove the bandage and/or cast, check the wound and place you in an appropriate brace (will vary with type of surgery performed, the stability of the repair etc.)
•You will also be referred for physiotherapy to supervise and monitor your rehabilitation
•You will be allowed to weight bea as tolerated with the brace on, and this can be with or without crutches. You should be able to walk without crutches within 2-4 weeks of the surgery.
•Physiotherapy sessions will concentrate on restoring the normal range of movement in the dorsi-plantar flexion and eversion-supination directions. The physiotherapist will also instruct you in strengthening exercises in each of these directions. No inversion-supination movements are allowed until 6 weeks post surgery. You will also perform balancing exercises.
Second post-operative review
•The surgeon will see you for your second post-operative review at about 6 weeks post surgery. He will check the quality of the repair and healing
•At this stage he will usually recommend weaning yourself off the use of the brace for activities of daily living, but it should be worn for all sporting activities until told otherwise.
•It should also be worn whenever working on, or walking over, uneven ground
•You should be able to swim and cycle with or without the brace on. An air cast stirrup may be recommended for these activities.
•You should be able to return to running (even surfaces) wearing the air-cast stirrup.
•Over this period you should be able to make a graded return to full sports activity, aiming for unrestricted sports participation within 6 months.
•This should be worn until the ankle has regained full stability and is similar to the other (uninjured) ankle. However, for high-risk activities, such as volley-ball, basketball, netball, touch foot ball, orienteering etc. it is recommended that you continue to wear the air-cast brace or a lace-up ankle brace indefinitely.