Arthroscopic resection and debridement for sinus tarsi syndrome with too-long anterior process of the calcaneus: short-term results

doi:10.3877/cma.j.issn.1674-6899.2026.03.008

Abstract

Abstract:

Objective

To investigate the clinical efficacy of arthroscopic resection of the too-long anterior process (TLAP) of the calcaneus combined with sinus tarsi debridement in the treatment of sinus tarsi syndrome (STS) with a too-long anterior process of the calcaneus.

Methods

A retrospective analysis was conducted on the clinical data of 7 patients with refractory STS with TLAP admitted from Sep. 2023 to Sep. 2025. All patients underwent arthroscopic resection of TLAP combined with sinus tarsi debridement. The American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale, foot and ankle outcome score(FAOS) , and visual analogue scale (VAS) pain score were recorded preoperatively and at 1, 3, and 6 months postoperatively. The incidence of complications including infection, skin necrosis, tendon injury, or deep vein thrombosis of the lower extremity, the recurrence rate of sinus tarsi pain, and the time to return to activity were documented to evaluate the clinical outcomes.

Results

All 7 patients successfully underwent surgery and completed the entire follow-up period. At 6 months after treatment, the patients′ FAOS score increased from 42.86±6.84 to 90.86±4.6, the VAS pain score decreased from 7.14±1.34 to 1.71±0.76, and the AOFAS score improved from 40.14±4.71 to 85.29±3.23. No postoperative complications occurred in any patient. At the final follow-up, no recurrence was observed in any patient.

Conclusion

For STS with TLAP, arthroscopic resection of TLAP combined with tarsal sinus debridement can significantly improve foot and ankle function and relieve pain, with low complication and recurrence rates, yielding satisfactory short-term clinical outcomes.

Key words: Sinus tarsi syndrome(STS), Too-long anterior process(TLAP), Arthroscopy

Pengfei Li, Zihao Huang, Ketao Wang, Feng Qu. Arthroscopic resection and debridement for sinus tarsi syndrome with too-long anterior process of the calcaneus: short-term results[J]. Chinese Journal of Laparoscopic Surgery(Electronic Edition), 2026, 19(03): 165-170.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhqjwkzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-6899.2026.03.008

https://zhqjwkzz.cma-cmc.com.cn/EN/Y2026/V19/I03/165

Figures/Tables 5

References 21

[1]	O′connor D. Sinus tarsi syndrome: a clinical entity[J]. J Bone Joint Surg Am, 1958, 40(4)：720.
[2]	Lektrakul N, Chung CB, Lai YM, et al. The tarsal sinus: arthrographic, MR imaging, MR arthrographic, and pathologic findings in cadavers and retrospective study data in patients with sinus tarsi syndrome[J]. Radiology, 2001, 219(3)：802-810.
[3]	Rouvreau P, Pouliquen JC, Langlais J, et al. Synostosis and tarsal coalitions in children: a study of 68 cases in 47 patients[J]. Rev Chir Orthop, 1994, 80：252-260.
[4]	Arshad Z, Bhatia M. Current concepts in sinus tarsi syndrome: a scoping review[J]. Foot Ankle Surg, 2021, 27(6)：615-621
[5]	Toy S, Tuncer K, Topal M, et al. Corticosteroid, platelet－rich plasma, and ozone injections for sinus tarsi syndrome[J]. J Am Podiatr Med Assoc, 2023, 113(1)：220-221.
[6]	Wang CJ, Weng LH, Ko JY, et al. Extracorporeal shockwave therapy shows chondroprotective effects in osteoarthritic rat knee[J]. Arch Orthop Trauma Surg, 2011, 131(8)：1153-1158.
[7]	Lui TH, Pan X, Chan CK. Arthroscopic resection of too-long anterior process (TLAP) of the calcaneus, anterior subtalar synovectomy, debridement of the sinus tarsi, and posterior subtalar adhesiolysis via anterolateral subtalar and dorsolateral midtarsal portals[J]. Arthrosc Tech, 2021, 10(10)：e2259-e2264.
[8]	Lucchesi G, Bonnel F, Mainard N, et al. Interrelations Between the Too-Long Anterior Calcaneal Process, Hind and Mid-tarsal Bone Volumes, Angles and Osteochondral Lesion of the Dome of the Talus: Analysis by Software Slicer of 69 CT Scan of Feet[J]. Indian J Orthop, 2022, 56(12): 2228-2236.
[9]	Lui TH. Arthroscopic resection of the calcaneonavicular coalition or the "too-long" anterior process of the calcaneus[J]. Arthroscopy, 2006，22(8): 903.e1-e4.
[10]	Arceri A, Mazzotti A, Di Paola G, et al. What is inside the Sinus Tarsi? mechanoreceptor distribution, typing and clinical relevance—a histological and immunohistochemical synthesis[J]. Biomedicines, 2025, 13(12): 3052.
[11]	Dellon AL, Barrett SL. Sinus tarsi denervation: clinical results[J]. J Am Podiatr Med Assoc, 2005, 95(2): 108-113.
[12]	Rab M, Ebmer J, Dellon AL. Innervation of the sinus tarsi: implications for treating anterolateral ankle pain[J]. Ann Plast Surg, 2001, 47(5)：500-504.
[13]	Frey C, Feder KS, DiGiovanni C. Arthroscopic evaluation of the subtalar joint: Does sinus tarsi syndrome exist？[J] Foot Ankle Int, 1999, 20(3): 185-191.
[14]	Pisani G, Pisani PC, Parino E. Sinus tarsi syndrome and subtalar joint instability[J]. Clin Podiatr Med Surg, 2005, 22(1): 63-77.
[15]	Rosello O, Solla F, Oborocianu I, et al. Too-long calcaneal process: results of surgical treatment and prognostic factors[J]. Orthop Traumatol Surg Res, 2016, 102(5): 663-667.
[16]	Pellegrini MJ, Glisson RR, Wurm M, et al. Systematic quantification of stabilizing effects of subtalar joint soft-tissue constraints in a novel cadaveric model[J]. J Bone Joint Surg Am, 2016, 98(10)：842-848.
[17]	Lee KB, et al. Subtalar arthroscopic procedures for sinus tarsi syndrome[J]. Arthroscopy, 2008, 24(10): 1130-1134.
[18]	曲峰，孙成宜，王克涛，等. 关节镜下后踝三入路切除术治疗疼痛性跟距骨桥[J/OL]. 中华腔镜外科杂志(电子版), 2023, 16(2)：106-110.
[19]	Tümer N, Vuurberg G, Blankevoort L, et al. Typical shape differences in the subtalar joint bones between subjects with chronic ankle instability and controls[J]. J Orthop Res, 2019, 37(9): 1892-1902.
[20]	El Hayek T, D′ollone T, Rubio A, et al. A too-long anterior process of the calcaneus: a report of 31 operated cases[J]. J Pediatr Orthop B, 2009, 18(4)：163-166.
[21]	Lui TH. Arthroscopic resection of too-long anterior process of the calcaneus[J]. Arthrosc Tech, 2016, 5(5): e1179-e1183.

患者编号	性别	年龄	患侧	病程(月)	术前功能评分
患者编号	性别	年龄	患侧	病程(月)	FAOS	VAS	AOFAS
1	男	33	左	7	38.66	8	33
2	男	27	右	6	44.74	8	37
3	男	49	右	11	46.70	5	39
4	女	28	左	14	40.78	7	40
5	女	23	右	18	51.22	9	41
6	女	33	右	25	30.59	7	43
7	女	46	右	4	47.32	6	48

患者编号	性别	年龄	患侧	病程(月)	术前功能评分
患者编号	性别	年龄	患侧	病程(月)	FAOS	VAS	AOFAS
1	男	33	左	7	38.66	8	33
2	男	27	右	6	44.74	8	37
3	男	49	右	11	46.70	5	39
4	女	28	左	14	40.78	7	40
5	女	23	右	18	51.22	9	41
6	女	33	右	25	30.59	7	43
7	女	46	右	4	47.32	6	48

	FAOS评分			AOFAS评分			VAS评分
		95%置信区间	P值		95%置信区间	P值		95%置信区间	P值
术前	42.86±6.84	－	－	40.14±4.71	－	－	7.14±1.34	－	－
术后1月	69.43±3.78	[19.93, 33.22]	<0.01	64.71±2.83	[19.96，29.19]	<0.01	4.43±0.98	[1.19，4.24]	<0.01
术后3月	82.70±2.14	[33.95，45.76]	<0.01	77.57±1.72	[33.62，41.24]	<0.01	2.71±0.76	[2.59，5.41]	<0.01
术后6月	90.86±4.60	[41.21，54.79]	<0.01	85.29±3.23	[40.21，50.09]	<0.01	1.71±0.76	[4.16，6.70]	<0.01

	FAOS评分			AOFAS评分			VAS评分
		95%置信区间	P值		95%置信区间	P值		95%置信区间	P值
术前	42.86±6.84	－	－	40.14±4.71	－	－	7.14±1.34	－	－
术后1月	69.43±3.78	[19.93, 33.22]	<0.01	64.71±2.83	[19.96，29.19]	<0.01	4.43±0.98	[1.19，4.24]	<0.01
术后3月	82.70±2.14	[33.95，45.76]	<0.01	77.57±1.72	[33.62，41.24]	<0.01	2.71±0.76	[2.59，5.41]	<0.01
术后6月	90.86±4.60	[41.21，54.79]	<0.01	85.29±3.23	[40.21，50.09]	<0.01	1.71±0.76	[4.16，6.70]	<0.01

Please choose a citation manager

Content to export