Sinus Tarsi Syndrome: Diagnosed on 99m-Tc MDP Bone SPECT/CT

Document Type: Case report

Authors

1 DNB Nuclear Medicine, Department of Nuclear Medicine, Army Hospital Research & Referral, New Delhi, India

2 Department of Nuclear Medicine, Army Hospital Research & Referral, New Delhi, India

Abstract

Sinus Tarsi Syndrome is a cause of chronic ankle instability and pain. MRI of the ankle has been the modality of choice for diagnosing the condition. However, SPECT-CT offers an alternate modality for diagnosing and evaluation of the condition. We present the case of a footballer who was suffering from chronic right leg pain despite receiving physiotherapy. He was being managed as a case of a chronic ankle sprain. Meanwhile, he was referred to the department as radiology for MRI of the ankle could not be performed as the patient felt claustrophobic. The patient subsequently underwent a 99mTc-MDP Bone scan. He was diagnosed to be suffering from sinus tarsi syndrome as it showed a characteristic pattern noted on 99mTc-MDP Bone scintigraphy. This case report reveals the potential of SPECT-CT as an alternative in the evaluation of chronic ankle sprain to MRI in segment of cases where MRI is not performed due to various reasons.

Keywords


  1. Ferkel RD, Karzel RP, Del Pizzo W, Friedman MJ, Fischer SP. Arthroscopic treatment of anterolateral impingement of the ankle. Am J Sports Med 1991; 19:440–446.
  2. Ogilvie-Harris DJ, Gilbart MK, Chorney K. Chronic pain following ankle sprains in athletes: the role of arthroscopic surgery. Arthroscopy 1997; 13:564–574
  3. Chicklore S, Gnanasegaran G, Vijayanathan S, Fogelman I. Potential role of multislice SPECT/ CT in impingement syndrome and soft-tissue pathology of the ankle and foot. Nucl Med Commun. 2013; 34:130–139.
  4. Williams T, Cullen N, Goldberg A, Singh D. SPECT-CT imaging of obscure foot and ankle pain. Foot Ankle Surg 2012; 18:30–33
  5. Braun BL. Effects of ankle sprain in a general clinic population 6 to 18 months after medical evaluation. Arch Fam Med. 1999 Mar-Apr. 8(2):143-8.
  6. Gerber JP, Williams GN, Scoville CR, Arciero RA, Taylor DC. Persistent disability associated with ankle sprains: a prospective examination of an athletic population. Foot Ankle Int. 1998 Oct. 19(10):653-60.
  7. Löfvenberg R, Kärrholm J, Sundelin G, Ahlgren O. Prolonged reaction time in patients with chronic lateral instability of the ankle. Am J Sports Med. 1995 Jul-Aug. 23(4):414-7.
  8. Bosein WR, Staples OS, Russel SW. Residual disability following acute ankle sprains. J Bone Joint Surg Am. 1955 Dec. 37- A (6):1237-43.
  9. Balduini FC, Tetzlaff J. Historical perspectives on injuries of the ligaments of the ankle. Clin Sports Med. 1982 Mar. 1(1):3-12.
  10. Lektrakul N, Chung CB, Lai Ym, Theodorou DJ, Yu J, Haghighi P, et-al. Tarsal sinus: arthrographic, MR imaging, MR arthrographic, and pathologic findings in cadavers and retrospective study data in patients with sinus tarsi syndrome. Radiology. 2001; 219 (3): 802-10. 
  11. Rosenberg ZS, Beltran J, Bencardino JT. From the RSNA Refresher Courses. Radiological Society of North America. MR imaging of the ankle and foot. Radiographics. 2000; 20 Spec No: S153-79.
  12. Akiyama K, Takakura Y, Tomita Y, Sugimoto K, Tanaka Y, Tamai S. Neurohistology of the sinus tarsi and sinus tarsi syndrome. J Orthop Sci. 1999; 4(4) p: 299-303.
  13. Helgeson K. Examination and Intervention for Sinus Tarsi Syndrome. North American Journal of Sports Physical Therapy 2009 February; 4(1):29-37 (level: A1).
  14. Usmani S1, Abu Al Huda F, Al Kandari F.Three-Phase 99mTc MDP Bone Scintigraphy and SPECT-CT in Sinus Tarsi Syndrome. Clin Nucl Med. 2016 Apr; 41(4):e208-10.