Ultrasound-guided decompression surgery of the tarsal tunnel: a novel technique for the proximal tarsal tunnel syndrome\u2014Part II

Teresa Vazquez,Simone Moroni,Vasco Starke,Alejandro Fernández-Gibello,Marko Konschake,Rubén Montes,Gabriel Camuñas,Christoph Tasch,Marit Zwierzina,José Sañudo

doi:10.1007/s00276-018-2127-9

Abstract

BackgroundThe aim of this study is to provide a safe ultrasound-guided minimally invasive surgical approach for a proximal tarsal tunnel release concerning nerve entrapments.Methods and resultsThe study was carried out on ten fresh-frozen feet. All of them were examined by high resolution ultrasound at the medial ankle region. The surgical approach was marked throughout the course of the flexor retinaculum (laciniate ligament). Once the previous steps were done, the flexor retinaculum release technique was carried out with a 2-mm entry only. As a result, an effective and safe release of the flexor retinaculum was obtained in all fresh-frozen feet.ConclusionThe results of our anatomic study indicate that our novel ultrasound-guided minimally invasive surgical approach for the release of the flexor retinaculum might be an effective, safe and quick decompression technique treating selected patients with a proximal tarsal tunnel syndrome.

Highlights

The tibial nerve (TN) often—mistakenly—in current literature named the “posterior tibial nerve”, takes its course within osteofibrous tubes and is vulnerable to an entrapment
The entrapment of the TN within the tarsal tunnel (TT), known as the tibio-calcaneal tunnel, calcaneal tunnel or Richets tunnel can occur in two different osteofibrous tubes: in the proximal tarsal tube and the distal tarsal tube [10]
The tarsal tunnel syndrome itself was first described by Keck et al and by Lam et al in two independent publications [22, 30]

Summary

Introduction

The tibial nerve (TN) often—mistakenly—in current literature named the “posterior tibial nerve”, takes its course within osteofibrous tubes and is vulnerable to an entrapment. The true incidence is unknown; a specific cause of the tarsal tunnel syndrome (TTS) can only be identified in 60–80% of the patients [24, 31] and has a slight female predominance (56%) [7]. The aim of this study is to provide a safe ultrasound-guided minimally invasive surgical approach for a proximal tarsal tunnel release concerning nerve entrapments. An effective and safe release of the flexor retinaculum was obtained in all fresh-frozen feet. Conclusion The results of our anatomic study indicate that our novel ultrasound-guided minimally invasive surgical approach for the release of the flexor retinaculum might be an effective, safe and quick decompression technique treating selected patients with a proximal tarsal tunnel syndrome

Objectives

Methods

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Discussion

Conclusion