Ultrasound-guided decompression surgery of the distal tarsal tunnel: a novel technique for the distal tarsal tunnel syndrome\u2014part\xa0III

Simone Moroni,Gabriel Camunas Nieves,Marko Konschake,Alejandro Fernández Gibello,Marit Zwierzina,Teresa Vazquez,José Sañudo,Rubén Montes

doi:10.1007/s00276-019-02196-w

Abstract

BackgroundThe aim of this study was to provide a safe ultrasound-guided minimally invasive surgical approach for a distal tarsal tunnel release concerning nerve entrapments.Methods and resultsThe study was carried out on ten fresh-frozen feet. All of them have been examined by high-resolution ultrasound at the distal tarsal tunnel. The surgical approach has been marked throughout the course of the medial intermuscular septum (MIS, the lateral fascia of the abductor hallucis muscle). After the previous steps, nerve decompression was carried out through a MIS release through a 2.5 mm (± 0.5 mm) surgical portal. As a result, an effective release of the MIS has been obtained in all fresh-frozen feet.ConclusionThe results of our anatomic study indicate that this novel ultrasound-guided minimally invasive surgical approach for the release of the MIS might be an effective, safe and quick decompression technique treating selected patients with a distal tarsal tunnel syndrome.

Highlights

IntroductionThe true incidence of the tarsal tunnel syndrome (TTS) is unknown [7], but a specific cause can be identified in 60–80% of the patients [18, 24], the literature states a 50% idiopathic cause of the TTS [41]
Reducing the space within the tarsal tunnel leads to an entrapment of the tibial nerve (TN) and/or its branches and increases the risk of sensorimotor neuropathy and diabetic foot complications [31]
Different studies show that in the chronic plantar heel pain syndrome, a focal entrapment of a single TN branch or a direct, more proximal entrapment of the TN can be found in the tarsal tunnel in 88%; this exists as a single entity or in association with other causes [28, 36]

Summary

Introduction

The true incidence of the TTS is unknown [7], but a specific cause can be identified in 60–80% of the patients [18, 24], the literature states a 50% idiopathic cause of the TTS [41] In those cases, in which space-occupying mass or systemic disorders, except diabetes, are not present, the etiology for a TTS has been hypothesized as being a fibrosis and/or thickening of osteofibrous structures at this critical anatomic region [32]. The aim of this study was to provide a safe ultrasound-guided minimally invasive surgical approach for a distal tarsal tunnel release concerning nerve entrapments. Conclusion The results of our anatomic study indicate that this novel ultrasound-guided minimally invasive surgical approach for the release of the MIS might be an effective, safe and quick decompression technique treating selected patients with a distal tarsal tunnel syndrome

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Conclusion