Ultrasound-Guided Near-Nerve Needle Sensory Technique for the Diagnosis of Tarsal Tunnel Syndrome.

Lorena Vega-Zelaya,Álvaro Iborra,Jesús Pastor,Manuel Villanueva,Concepción Noriega

doi:10.3390/jcm10143065

Abstract

Background: Tarsal tunnel syndrome (TTS) is one of the most common entrapment syndromes. Although diagnosis is supported by imaging tests, it has so far been based on clinical findings. Neurophysiological tests are not effective for providing an accurate diagnosis. The objective of this study was to analyze the efficacy of the ultrasound-guided near-nerve needle sensory technique (USG-NNNS) for the diagnosis of TTS Methods: The study population comprised 40 patients referred for a neurophysiological study owing to clinical suspicion of TTS. Routine neurophysiological tests were performed and compared with the results of USG-NNNS. Results: The diagnosis of TTS was achieved in 90% of cases. We found significant differences between lateral plantar sensory recordings with surface electrodes and USG-NNNS techniques for amplitude, nerve conduction velocity (NCV), and duration. As for the medial plantar sensory recordings, differences were found only for duration. No responses were obtained with surface electrode studies in 64.8% of cases. In addition, we observed normal sensory NCV with surface electrodes in 20 patients, although this decreased when the NNNS technique was used. Conclusions: This is the first report of the efficacy of the USG-NNNS technique for confirming the diagnosis of TTS.

Highlights

Tarsal tunnel syndrome (TTS) is an entrapment syndrome of the entire tibial nerve (TN) or its terminal branches behind the medial malleolus and under the flexor retinaculum and the deep fascia of the abductor hallucis muscle [1,2]
For maximum nerve conduction velocity (NCV) (MaxNCV), we considered onset latency
41.1 ± 0.7 m/s and 29.0 ± 1.0 m/s, respectively, with a duration of 3.9 ± 0.3 ms. When we compared these results with those of the group of symptomatic patients, we found significant differences with respect to the MaxNCV, minimum NCV (MinNCV), and duration for we found significant differences with respect to the MaxNCV, MinNCV, and duration both the medial and the lateral nerve (p < 0.001)

Summary

Introduction

Tarsal tunnel syndrome (TTS) is an entrapment syndrome of the entire tibial nerve (TN) or its terminal branches (medial plantar, lateral plantar, and calcaneal nerves) behind the medial malleolus and under the flexor retinaculum (or laciniate ligament) and the deep fascia of the abductor hallucis muscle [1,2]. The symptoms described include a variety of alterations ranging from posteromedial pain and numbness in the sole of the foot, tightness, and cramps that are initially intermittent but can be accentuated by prolonged standing or walking [4]. Pain at night is common and often severe enough to awaken the patient. Clinical signs on physical examination include posteromedial tenderness over the nerve, a positive Tinel sign, and, in some cases, bulging of the retinaculum. Objective negative signs, including hypoesthesia and claw toes, may be observed [1,4,5]

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