Giorgini R J, Bernard R L
New York College of Podiatric Medicine, NY 10019.
J Am Podiatr Med Assoc. 1990 Apr;80(4):218-22. doi: 10.7547/87507315-80-4-218.
The literature reports that 70% of the cases of sinus tarsi syndrome are post-traumatic, following an inversion sprain, and that 30% result from inflammatory disorders, such as rheumatoid arthritis, ankylosing spondylitis, and gouty arthritis. However, in the case presented, talipes equinovarus deformity and sinus tarsi syndrome coexisted. One of the corrective goals in the management of the talipes equinovarus deformity is the realignment of the articulation between the medial plantarly deviated talar head and the anteromedial segment of the calcaneus. The calcaneus must be rotated from a plantarflexed position into a dorsiflexed position. The posterior tubercle will be moved down and in, with the anterior process moved up and out away from the talar head. By correcting the plantarflexed varus attitude of the calcaneus, it is put in a valgus position that often closes down the sinus tarsi upon weightbearing. This compression may result in pain over the lateral aspect of the midfoot with hindfoot instability, as seen in the case presented. As a result of the abnormal anatomical relationship of the talus and calcaneus, the patient developed severe pain in the sinus tarsi. Based on the medical history and present postoperative results, the authors find a long-term sequela of talipes equinovarus deformity to be sinus tarsi syndrome.
文献报道，跗骨窦综合征70%的病例为创伤后所致，继发于内翻扭伤，30%由炎症性疾病引起，如类风湿关节炎、强直性脊柱炎和痛风性关节炎。然而，在本病例中，马蹄内翻足畸形与跗骨窦综合征并存。马蹄内翻足畸形治疗的矫正目标之一是使跖侧内偏的距骨头与跟骨的前内侧段之间的关节重新对线。跟骨必须从跖屈位旋转至背屈位。后结节将向下向内移动，而前突则向上向外移动远离距骨头。通过纠正跟骨的跖屈内翻姿势，使其处于外翻位，负重时跗骨窦常被封闭。这种压迫可能导致中足外侧疼痛伴后足不稳，如本病例所见。由于距骨和跟骨的解剖关系异常，患者跗骨窦出现严重疼痛。根据病史和目前的术后结果，作者发现马蹄内翻足畸形的一个长期后遗症是跗骨窦综合征。
