Patients with foot sprains are often encountered in life. If there is no fracture, they can mostly heal with medical treatment and proper rest. Some patients, on the other hand, often experience pain in the foot. They have been transferred to several departments such as surgery, orthopedics and rehabilitation physiotherapy, and the treatment as foot sprain is not effective, mainly because of wrong diagnosis. In fact, this disease may be the tarsal sinus syndrome. Over the past few years, I have treated dozens of similar patients, all of whom were diagnosed with tarsal sinus syndrome and achieved good results with radiofrequency treatment.
Radiofrequency thermal coagulation denervation for tarsal sinus syndrome, also known as tarsal sinusitis, is a syndrome characterized by swelling, pain, and abnormal sensation in the foot and lower leg caused by lesions in the tarsal sinus.
1.Clinical information
General data
There were 26 cases in this group, 11 males and 15 females, aged 16 to 45 years old, with an average of 23 years old. The duration of the disease was from 3 months to 2 years. All cases were diagnosed by CR and/or MRI, and the clinical symptoms and signs were consistent with the imaging examination. The onset of disease was left-sided in 10 cases, right-sided in 14 cases, and bilateral in 2 cases. There were 24 cases with obvious history of foot trauma and 2 other cases.
Clinical manifestations
Swelling and fullness in the tarsal sinus area, pain and discomfort, weakness in walking, coldness in the posterior region of the foot and lower leg, pain and numbness, etc., which were aggravated when the foot was rotated or inwardly retracted. The pain is localized when walking, especially on uneven surfaces. Most patients have symptoms of tenderness, but no mechanical instability.
Physical signs
(1) Pressure pain: sharp pressure pain in the tarsal sinus area.
(2) Passive ankle inversion pain: pain in the tarsal sinus area when the ankle is done with passive inversion or posterior rotation examination.
(3) Drawer test and inversion test: no ankle instability.
Auxiliary examination
(1)X-ray: including anteroposterior and lateral views of the ankle joint, usually without abnormal findings.
(2)MRI: It can show partial rupture of the tarsal sinus ligament and soft tissue edema. It can also exclude the osteochondral injury of the ankle joint and talocrural joint, as well as the old injury of the lateral collateral ligament of the ankle joint.
Diagnosis and differential diagnosis
(1) Old injury of the lateral collateral ligament of the ankle joint: symptoms are mainly unstable, pressure points are at the anterior talofibular ligament or heel-fibular ligament, drawer test and inversion test reveal poor stability of the ankle joint, MRI can show old injury of the ligament.
(2) Injury of the subtalar joint: CR or MRI has signs of osteochondral injury of the subtalar joint.
(3) Diagnostic closure: local injection of 2% lidocaine 2ml into the tarsal sinus, if the pain disappears, the diagnosis of tarsal sinus syndrome can be confirmed.
Treatment
Routinely check blood, urine, electrocardiogram, coagulation function, etc. before operation, prepare RF pain treatment instrument (Xi’an Tangcheng XJ-03 type), routinely sterilize and lay sterile towel, after local anesthesia, take 0.9x12cm RF puncture needle, enter 2~3cm from 3 points of sinus, set stimulation parameters as 0.5v_50Hz, 2v_2Hz, perform square wave stimulation, when After the pain response was induced, 70°~30″, 80°~30″, 90°~180″ radiofrequency thermal coagulation denervation was performed respectively. In the same way, 6, 9 and 12 points sinus puncture and radiofrequency thermal coagulation denervation were performed.
2.Results
(1) A total of 26 patients were treated and 28 tarsal sinuses were punctured. The intraoperative positioning was accurate and the success rate of puncture was 100%. No complications such as nerve and vascular injury occurred.
(2) Efficacy assessment.
Cured: no pressure pain at the tarsal sinus orifice, no soreness and pain when standing and walking, no abnormal sensation. Improvement: the pressure pain at the tarsal sinus opening is reduced, there is still soreness and pain when standing and walking, and the abnormal sensation is reduced. Ineffective: no improvement of symptoms [2]. All patients were treated once in the outpatient clinic and followed up the efficacy by telephone and by coming to the hospital for follow-up. A total of 23 patients were followed up, and the number of excellent and good cases in January and March after treatment were: excellent 20 (86.9%) and good (13.1%) in January; excellent 19 (82.6%) and good 4 (17.4%) in March. The excellent rate was 100%.
3.Discussion
Tarsal sinus syndrome was first proposed by O’Connor in 1957, and its typical presentation is chronic pain in the lateral ankle and tarsal sinus, mostly with a history of trauma. The tarsal sinus is a conical cavity located between the neck of the talus and the anterosuperior aspect of the heel bone, which runs posteriorly and anteriorly. It is lined by a funnel-shaped tarsal sinus canal, which is immediately posterior to the talar process. The tarsal sinus is the division between the posterior heel talar joint and the anterior and middle joints, and the major structures in it include the fat pad, small blood vessels, joint capsule, nerve endings, bursa, and ligaments (the medial, middle, and lateral roots of the heel talar interosseous ligament, the cervical ligament, and the subextensor support band).
The most common cause of tarsal sinus syndrome is trauma, with approximately 70% of patients having a history of ankle trauma (entropion injury). The ligamentous structures in the tarsal sinus have a role in limiting excessive pronation of the subtalar joint. In a posterior foot rotation injury, the heel-fibular ligament ruptures first, followed by the cervical ligament and the intercalary heel ligament. Tendon ligament injury and post-traumatic fibrosis of the joint are the main causes of tarsal sinus syndrome. Other than that, about 30% of patients have no history of trauma and are associated with foot deformity, gouty arthritis or rheumatoid arthritis, etc. Tumors of the foot may also cause tarsal sinus syndrome, and additional cases of medical origin of tarsal sinus syndrome have been reported.
Radiofrequency therapy technology is a technique that treats diseases by producing local high temperature in local tissues through precise output of ultra-high frequency radio waves by specific puncture needles, which plays a role in thermal coagulation or cutting, and is therefore called radiofrequency thermocoagulation or radiofrequency ablation. The radiofrequency instrument used for pain treatment has a nerve stimulation function, which can find and accurately locate sensory and motor nerves, and block or change the nerve conduction with radiofrequency current, which can achieve the purpose of relieving pain. This physical neurothermal coagulation technique provides excellent control of the temperature and range of the thermal coagulation foci, and can reduce or eliminate pain while maintaining proprioceptive, tactile and motor functions after treatment.
Treatment of tarsal sinus syndrome includes ultrasonic physiotherapy, hydrotherapy, oral NSAIDs, and local closure. Injection of a mixture of 2 ml of 2% lidocaine and 1 ml of prednisolone into the tarsal sinus is about 50-70% effective. The authors applied radiofrequency thermal coagulation denervation for tarsal sinus syndrome, which not only significantly improved the efficacy, but also had no case of complications, which has clinical promotion significance.