Hoke’s Tonsil refers to the fibrofatty tissue (plug) in the sinus tarsi of the subtalar (talocalcaneal) joint. The sinus tarsi is a tunnel formed by the sulci calcanei (inferior) and the sulci tali (superior). In addition to this fibrofatty tissue that makes up Hoke’s tonsil the sinus tarsi also contains arteries (deltoid), artery of sinus tarsi, nerves, the interosseous talocalcaneal ligament and the medial attachment of inferior extensor retinaculum.
The nerve in the sinus tarsi can become irritated leading to a sinus tarsitis. Hoke’s tonsil can be surgically removed to denervate the sinus tarsi leading to symptomatic relief of the sinus tarsitis or a sinus tarsi syndrome. This denervation of the sinus tarsi won’t impact the mechanical issues that are causing the issue, but will eliminate the pain.
During surgeries, such as a triple arthrodesis, Hoke’s tonsil needs to be removed to adequately visualize the subtalar joint.
The origins of the term ‘Hoke’s tonsil’ is unknown. The ‘tonsils’ are a pair of masses of lymphoid tissue in the throat. The term ‘tonsil’ can also refer to mass of ‘lymphoid tissue’ which is similar to tonsils in the throat. This could be how it got it name.
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