Clinical Results Following Revision Tibial Nerve Release

Abstract

The results following revision tarsal tunnel release in 12 patients (13 feet), including three men and nine women aged 28 to 66 years, are presented. The indication for surgery was incapacitating focal pain, associated with paresthesias and hyperesthesias, refractory to nonoperative treatment modalities. Electrodiagnostic studies were abnormal in nine and normal in four cases. Revision surgery was performed a mean 3.5 years (range 1-10 years) after the initial tarsal tunnel release. Epineurolysis was performed in nine of the 13 cases where the nerve was encased in a scar. An insufficient previous distal release was identified in nine of the 13 cases. Wound infection occurred in two patients, one of whom ultimately underwent a below the knee amputation. With the exception of this patient, all patients were evaluated a mean 31 months (range 12-59 months) after the revision surgery. Three groups of patients were identified based on similarities in presentation, intraoperative findings, and clinical outcome. The first group (four feet), characterized by encasement of the tibial nerve in scar and an adequate distal release at the previous tarsal tunnel surgery, did poorly. The second group (five feet), with both scarring of the tibial nerve and an inadequate prior distal release, had somewhat mixed results, but overall were improved. The final group (four feet), who had no significant tibial nerve scarring but had had an inadequate prior distal release, did well. Clinical history and physical examination were more helpful than electrodiagnostic studies in determining the extent and location of the tibial nerve irritation following previous tarsal tunnel release surgery.