Treatment Of Tarsal Tunnel Syndrome Research Articles

Zig-Zag Skin Incision for Treatment of Tarsal Tunnel Syndrome.

Tarsal tunnel syndrome (TTS) is a common entrapment neuropathy of the posterior tibial nerve. Surgery can be performed less invasively under local anesthesia. We adopted zig-zag skin incision to prevent postoperative wound complications. Between July 2022 and June 2023, we operated on 19 legs of 14 consecutive TTS patients (5 males, 11 females; average age 73.3 years). We made a 2- to 3-cm zig-zag skin incision on the tarsal tunnel. After posterior tibial nerve decompression by posterior tibial artery (PTA) transposition, the subcutaneous layer was tightly sutured with 4-0 PDS and the skin was closed with Dermabond Advanced. We investigated adverse events that developed during the first 30 postoperative days and recorded surgical outcomes at the final visit. In all patients the nerves were successfully decompressed with PTA transposition. There were no intraoperative complications. During the 30 postoperative days there were no adverse events, including wound complications, and patients' symptoms improved significantly. Zig-zag skin incision was easy and convenient for surgical TTS treatment and may be useful for preventing postoperative wound complications.

Open Capsular Repair with Dermal Allograft and Tarsal Tunnel Release in the Treatment of Tarsal Tunnel Syndrome in a Young Collegiate Athlete

Tarsal tunnel syndrome is an entrapment neuropathy of the posterior tibial nerve beneath the flexor retinaculum that can be precipitated by either intrinsic or extrinsic factors. We report a unique case of a posterior medial ankle joint capsular defect with localized fluid extravasation between the flexor digitorum longus (FDL) and flexor hallucis longus (FHL) leading to symptoms consistent with tarsal tunnel syndrome in a collegiate tennis player.

Clinical Results Following Conservative Management of Tarsal Tunnel Syndrome Compared With Surgical Treatment: A Systematic Review.

Posterior tarsal tunnel syndrome involves entrapment of the posterior tibial nerve as it travels in the groove posterior to the medial malleolus. Conventional wisdom dictates that patients with tarsal tunnel syndrome be treated with conservative treatment and medical management, with surgical options available for patients with refractory symptoms and good candidacy. Minimally invasive options for neuropathic entrapment syndromes have developed in recent years and may provide a therapeutic role in tarsal tunnel syndrome. The present investigation provides a summary of the current state of knowledge on tarsal tunnel syndrome and a comparison between minimally invasive and surgical treatment options. The literature search was performed in Mendeley. Search fields were varied until redundant. All articles were screened by title and abstract and a preliminary decision to include an article was made. A full-text screening was performed on the selected articles. Any question regarding the inclusion of an article was discussed by 3 authors until an agreement was reached. Most commonly tarsal tunnel syndrome is idiopathic. Other reported causes include post-traumatic, lipomas, cysts, ganglia, schwannomas, ganglia, varicose plantar veins, anatomic anomalies, and systematic inflammatory conditions. Several risk factors have been described including female gender, athletic participation, hypothyroidism, diabetes mellitus, systemic sclerosis, chronic renal failure, and hemodialysis use. A few recent studies demonstrate anatomic variants that have not previously been summarized. Three articles describe clinical outcomes after conservative treatment with acceptable results for first line treatment. Two primary articles report on the use of minimally invasive treatment for tarsal tunnel syndrome. Fourteen articles report on the clinical outcomes after surgical management. Clinical understanding of tarsal tunnel syndrome has evolved significantly, particularly with regards to the pathoanatomy of the tarsal canal over the past twelve years. A few novel anatomic studies shed light on variants that can be helpful in diagnosis. Conservative management remains a good option that can resolve the symptoms of many patients. As more prospective cohorts and clinical trials are performed on minimally invasive options, pulsed radiofrequency and neuromodulation may evolve to play a larger role in the treatment of this condition. Currently, surgical treatment is only pursued in a very select group of patients with refractory symptoms that do not respond to medical or minimally invasive options. Surgical outcomes in the literature are good and current evidence is stronger than that for minimally invasive options.

Clinical anatomical study on the treatment of tarsal tunnel syndrome with four-point vertical acupotomy

To explore safety and accuracy of four-point acupotomy for the treatment of tarsal tunnel syndrome regarding release of ankle tunnel flexor retinaculum to provide an anatomical basis of clinical treatment. Twenty-nine adult specimens (15 males and 14 females) fixed with 10% formalin, aged from 47 to 98 years old with an average age of (81.10±11.14) years old, 29 on the right side and 29 on the left side, which were selected for the study from September 2020 to October 2020. Simulate the operation of loosening flexor retinaculumt with a needle knife on the human specimen, and place the specimen on the frog position of lower limbs with medial malleolus upward to determine the center of medial malleolus. Choose 4 different positions near the flexor retinaculum to insert the needle so that the needle body was perpendicular to skin and cutting edge direction was perpendicular to the running direction of the flexor retinaculum. The needle knife penetrates the skin and explores slowly. When the flexor retinaculum was reached, the needle tip may touch the tough tissue. At this time, the cutting is loosened for 4 times. After acupotomy release operation was completed, make a lateral incision on the skin surface along acupotomy direction, open the area of the exposed flexor retinaculum, dissecting layer by layer, observe and record the needle knife and its surrounding anatomical structure. The length of acupotomy cutting marks of flexor retinaculum was measured by electronic vernier caliper. The safety and accuracy of acupotomy loosening of ankle canal flexor retinaculum were evaluated by observing the number and degree of ankle canal contents such as tendons and nerves injured by needle knife. The safety is to count the number of cases of acupotomy injury to the contents of the ankle canal, and to calculate the injury rate, that is, the number of injury cases/total cases × 100%. The effective release was defined as the release length L ≥ W/2(W is the width of the flexor retinaculum, defined as 20 mm). For safety, there were no acupotomy injuries to nerves or blood vessels in 58 cases, 26 cases injuried to posterior tibial tendon which 17 of these tendon injury cases, the tendon was penetrated and severely injured, and flexor digitorum longus tendon was injured in 12 cases. Among these cases, tendon was penetrated and severely injured in 4 cases, and total injury rate was 32.14%. No nerve and vessel injury on c3 and c4 point. For accuracy, 58 specimens were successfully released. The length Lc of releasing trace for acupotomy was (10.40±1.36) cm, and length range 6.38 to 12.88 cm. Among all cases, the length of releasing trace was ≥10 mm in 37 cases. The overall success rate of release was 100.00%. Layered structure of ankle tube flexor retinaculumt:fiber diaphragm from flexor retinaculum divides contents of ankle tube into different chambers inward, and fiber diaphragm meets here to synthesize a complete flexor retinaculum at the midpoint of the line between the medial malleolus tip and calcaneal tubercle(above the neurovascular course). Four-point needle-knife method of releasing flexor retinaculum for the treatment of tarsal tunnel syndrome is performed at the attachment of the two ends of flexor retinaculum;the tendon, but not the nerves and blood vessels, is easily damaged. It is safe to insert needle on the side of calcaneus. The extent of release is relatively complete, but due to the "layered" structure of the flexor retinaculum, classic surgical technique could only release one layer of flexor retinaculum when a needle is inserted at the edge of the bone and cannot achieve complete release of the full thickness of the flexor. Therefore, it remains to be determined whether the desired effect can be achieved clinically.

The Course of Tarsal Tunnel Syndrome after Ultrasound-Guided Injections.

Local ultrasound (US)-guided injections of anesthetics with corticosteroids are commonly performed for the conservative treatment of tarsal tunnel syndrome (TTS). This retrospective study aimed to investigate the outcomes of TTS after US-guided injections. The study included patients who were diagnosed with TTS and received US-guided injections as part of their initial treatment. The pain levels were noted on a scale between zero and ten before and after each injection. The patients were divided into non-surgical and surgical groups. The nonsurgical group included patients who had received US-guided injections and did not proceed to surgical treatment, and the surgical group included those who received US-guided injections and ultimately underwent tarsal tunnel release (TTR). The two groups were compared in terms of age, post-injection follow-up time, and the amount of pain reduction immediately after injection (ΔPN). In the surgical group, outcomes of surgical treatment were also assessed. A total of 218 patients were diagnosed with TTS and received US-guided injections. After the injections, 169 patients (77.5%) did not go on to TTR (nonsurgical group) and 49 patients (22.5%) underwent TTR (surgical group). The average ages for the nonsurgical and surgical groups were 53.8 and 48.9 years (P = 0.03). The average time between the injection and final follow-up for the nonsurgical group was 339 days. The average time between the injection and TTR for the surgical group was 145 days. There were no differences in pain relief after the injections between the nonsurgical and surgical groups (mean ΔPN: 3.6 and 3.8, respectively). The average post-surgical follow-up time was 117 days. At final follow-up, 41 patients (84%) in the surgical group had complete resolution of pain and neurological symptoms. US-guided injection can be an effective conservative treatment option for patients with TTS. Younger patients may be more likely to proceed to TTR. Level III.

The Course of Tarsal Tunnel Syndrome after Ultrasound-Guided Injections

Category:Other; Ankle; Hindfoot; Midfoot/Forefoot; SportsIntroduction/Purpose:Local ultrasound (US)-guided injections of anesthetics with corticosteroids are commonly performed for the conservative treatment of tarsal tunnel syndrome (TTS). This retrospective study aimed to investigate the course of TTS after US-guided injections.Methods:The study included patients who were diagnosed with TTS and received US-guided injections as their initial conservative treatment. The patients' pain levels were noted on a scale between zero and ten before and after each injection. The patients were divided into two groups: nonsurgical and surgical groups. The nonsurgical group included patients who had received US-guided injections and were not treated surgically, and the surgical group included those who received US-guided injections and ultimately underwent surgical tarsal tunnel release (TTR). The two groups were compared in terms of age, gender, post-injection follow-up time, and the amount of pain reduction immediately after injection (ΔPN). In the surgical group, the presence or absence of additional foot and ankle pathologies requiring operative treatment during TTR, and outcomes of surgical treatment were also assessed.Results:218 patients were diagnosed with TTS and received US-guided injections as their initial treatment. After the injections, 169 patients (77.5%) required no TTR (nonsurgical group) and 49 patients (22.5%) underwent TTR (surgical group). The average ages for the nonsurgical and surgical groups were 53.8 and 48.9 years (P = 0.03). The average time between the injection and final follow-up for the nonsurgical group was 339 days. The average time between the injection and TTR for the surgical group was 145 days. There were no differences in pain relief after the injections between the nonsurgical and surgical groups (mean ΔPN: 3.6 and 3.8, respectively). In the surgical group, 16 patients (32%) presented with additional foot and ankle pathologies that were surgically treated during TTR. The average post-surgical follow up time was 117 days. At final follow up, 41 patients (84%) in the surgical group had no pain or functional impairment.Conclusion:US-guided injection can be an effective conservative treatment option for patients with TTS. Surgical release of tarsal tunnel may improve and resolve the overall symtoms of TTS in majority of the patients who do not respond to nonsurgical treatment. Younger age and additional foot and ankle pathologies appear to be associated with greater likelihood of undergoing TTR.

Tarsal Tunnel Syndrome: Outcome According to Etiology

Surgical results in tarsal tunnel syndrome are variable, and etiology seems to be a factor. Three possible etiologies can be distinguished. The aim of the present study was to compare surgical results according to etiology. Three continuous retrospective series (45 patients overall) of tarsal tunnel syndrome were compared. Group 1 presented a permanent intra- or extra-tunnel space-occupying compressive structure. Group 2 presented intermittent intra-tunnel venous dilatations. Group 3 comprised idiopathic tarsal tunnel syndrome. The mean follow-up was 3.6 +/- 1.8 years. The main endpoint was subjective postoperative improvement on Likert scale. Group 1 reported greater improvement than groups 2 and 3. Preoperative neuropathy on ultrasound was associated with poorer improvement, which was not the case for neuropathy on electromyography. Surgical treatment of tarsal tunnel syndrome provides better results in etiologies involving structural compression.

A failed conservative treatment of Tarsal Tunnel Syndrome (TTS) at Bhayangkara Hospital, Bali, Indonesia: a case report

Introduction: Tarsal Tunnel Syndrome (TTS) is the entrapment of the posterior tarsal nerve and its branches. This condition is uncommon and usually underdiagnosed. Misdiagnosing this condition will lead to unresolved symptoms. Pain and paraesthesia are the most common presenting symptoms. This case study aims to evaluate the failed conservative treatment of TTS.Case Description: A 32-years old woman presented to our clinic with pain and numbness in her left foot for 2 years. Her pain and numbness were worsened by prolonged standing and walking. Her symptoms were gradually relieved by rest and diagnosed with TTS. Surgery was performed under general anesthesia. A curvilinear incision was made posterior inferior to the medial malleolus of the left ankle. The flexor retinaculum was incised and the TTS was explored. The patient was evaluated every week for a month and a significant improvement was recorded without any complications.Conclusion: Surgery is indicated in TTS when conservative treatment has failed. This case study was treated by surgery decompression of the posterior tibial nerve due to failed conservative treatment.

Surgical Treatment of Tarsal Tunnel Syndrome - Case Report

The first description of tarsal tunnel syndrome is recent. Koppel in 1960 evoked the after-effects of lesions of the posterior tibial nerve. Keck in 1969 was the first to describe compression of the posterior tibial nerve by the internal annular ligament. It was a young soldier who, after intensive training, had bilateral plantar anesthesia. The opening of the internal annular ligament had allowed a total recovery in 48 hours. Our objective here is to discuss the circumstances of the diagnosis of this syndrome, to analyze its anatomical and pathological causes, to present the types of treatments followed, in the light of the literature.

The study of anatomy of tarsal tunnel in human fetuses by dissection method

Background: The flexor retinaculum of foot extends from the medial malleolus to the calcaneus to form the roof of tarsal tunnel. The structures passing through the tunnel are tendons of tibialis posterior, flexor digitorum longus & flexor hallucis longus, the tibial nerve & the posterior tibial artery with its venae comitantes. In order to understand the pathogenesis and improve the treatment of tarsal tunnel syndrome, we investigated the tarsal region of human foetuses anatomically. Methodology: The study was done on aborted/ stillborn foetuses in the Department of Anatomy of Sapthagiri Institute of Medical, Sciences, Bangalore. The structures passing under the flexor retinaculum of foot were dissected in 68 normal limbs of 34 foetuses of gestational age ranging from 10 weeks to term. Results: It was noted that the structures were arranged in two planes. Most commonly the superficial plane contained the tendon of tibialis posterior, posterior tibial artery & tibial nerve from medial to lateral side. In the deeper plane were the tendons of flexor digitorum longus medial to that of flexor hallucis longus. The bifurcation of tibial nerve mostly occurred under cover of flexor retinaculum and that of posterior tibial artery was distal to it. Conclusion: The understanding of arrangement of structures under cover of flexor retinaculum is important for diagnosis and treatment of tarsal tunnel syndrome in adults and also for the surgical correction of clubfoot, poliomyelitis & other deformities of foot in children.

Clinical Study of Acupotomy Treatment for Tarsal Tunnel Syndrome

Background: Compared with conventional closed therapy, acupotomy has the advantages of lower cost, convenient application, and better single and long-term effects. The aim of this study was to explore the clinical effect of acupotomy in the treatment of Tarsal Tunnel syndrome.Methods: There were 80 patients enrolled into the study who were randomly assigned to either the acupotomy or closed therapy group, with 40 patients in each group. The acupotomy group was treated once every 6 days, on 3 occasions for the duration of treatment, and the closed therapy group was treated twice a week, for 3 weeks as the course of treatment. The effects of treatment were analyzed and evaluated according to the standard of curative effect.Results: The “cure rate” of the number of patients in the acupotomy group whose symptoms had completely disappeared (13 patient out of 39) was higher than the closed therapy group (1 patient out of 39), and this difference was significant (<i>p</i> < 0.01). The number of patients in the acupotomy group who did not benefit from the therapy (5 patients) was significantly lower than the closed therapy group (15 patients; <i>p</i> < 0.05). The total number of patients in the acupotomy group who benefitted from the therapy (34 patients) resulted in an effective rate of 87.18%, which was higher than the closed therapy group (24 patients; 61.53%). The difference was statistically significant (<i>p</i> < 0.05).<br/>Conclusion: Acupotomy is effective in the treatment of Tarsal Tunnel syndrome, was superior to traditional closed therapy, and is worthy of clinical application.

Surgical Treatment of Tarsal Tunnel Syndrome

Surgical Treatment of Tarsal Tunnel Syndrome

Five cases of surgical treatment of tarsal tunnel syndrome

Five cases of surgical treatment of tarsal tunnel syndrome

Clinical analysis of ankle arthroscopy technique for treatment of tarsal tunnel syndrome

Objective: To explore the effects of ankle arthroscopy technique in treating the tarsal tunnel syndrome. Methods: From May 2014 to May 2016, the ankle arthroscopy technique was used for surgical treatment of tarsal tunnel syndrome in the Department of Hand and Foot Microsurgery in Xuzhou Central Hospital. Twenty-two patients with 24 feet with tarsal tunnel syndrome were hospitalized for treatment, with 10 left feet and 14 right feet, aged 26-57 years. The disease duration ranged from 4 to 15 months (mean 8.3 months). The dual-portals ankle arthroscopic neurolysis and fiber membrane resection were performed. The Pfeiffer scoring system was used to evaluate the post-operative outcomes. Results: Primarily healing of the wound was achieved in all the patients. No postoperative infection was found during the follow-up. The postoperative hospitalization time was 2 to 5 days (mean 3.7 days). All patients were followed up for 12 to 24 months. At the final follow-up, all the patients had significant improvement in numbness and pain. According to the Pfeiffer scoring system, the results were excellent in 16 feet, good in 8 feet, with an excellent and good rate of 100%. Conclusion: The ankle arthroscopic neurolysis is a safe and easy treatment option for the tarsal tunnel syndrome and provides satisfactory results.

Poster 249: Ultrasound Guided Tarsal Tunnel Injection for Diagnosis and Treatment of Tarsal Tunnel Syndrome: A Case Report

Poster 249: Ultrasound Guided Tarsal Tunnel Injection for Diagnosis and Treatment of Tarsal Tunnel Syndrome: A Case Report

Diagnosis and Treatment of Tarsal Tunnel Syndrome

Diagnosis and Treatment of Tarsal Tunnel Syndrome

Tarsal tunnel syndrome: Does etiology matter?

The tarsal tunnel syndrome is an uncommon condition. Surgical treatment is indicated whenever nonoperative management fails. Etiology is not always known. Does the result of surgical treatment depend on the etiology? The aim of this clinical study is to report our clinical results after surgical treatment for tarsal tunnel syndrome and to analyze the results depending on the etiology. Ten patients with tarsal tunnel syndromes were operated and the clinical outcome was measured by a pain visual analogue scale, the ankle-hindfoot AOFAS scale, and the degree of subjective satisfaction. Although significant improvement was found in the average visual analogue scale and AOFAS score, subjective satisfaction was less favorable. Patients were more satisfied when an etiology was found preoperatively, but statistic difference was not significant. Decompression of the tibial nerve should be considered with caution unless there is an associated lesion near or within the tarsal tunnel preoperatively. When indicated, extensive exposure guarantees adequate release.

Arterial Anatomy of the Posterior Tibial Nerve in the Tarsal Tunnel.

Both vascular and compression etiologies have been proposed as the source of neurologic symptoms in tarsal tunnel syndrome. Advancing the understanding of the arterial anatomy supplying the posterior tibial nerve (PTN) and its branches may provide insight into the cause of tarsal tunnel symptoms. The purpose of this study was to describe the arterial anatomy of the PTN and its branches. Sixty adult cadaveric lower extremities (thirty previously frozen and thirty fresh specimens) were amputated distal to the knee. The vascular supply to the PTN and its branches was identified, measured, and described macroscopically (the thirty previously frozen specimens, prepared using a formerly described debridement technique) and microscopically (the thirty fresh specimens, processed using the Spälteholz technique). On both macroscopic and microscopic evaluation, the PTN and the medial and lateral plantar nerves were observed to have multiple entering vessels within the tarsal tunnel. On microscopic evaluation, a vessel was observed to enter the nerve at the bifurcation of the PTN into the medial and lateral plantar nerves in twenty-two (73%) of the thirty specimens. There was a significant difference (p < 0.05) in vascular density between the PTN and each of its branches. The abundant blood supply to the PTN and its branches identified in this study is consistent with observations of other peripheral nerves. This rich vascular network may render the PTN and its branches susceptible to nerve compression related to vascular congestion. The combination of vascular and structural compression may also elicit neurologic symptoms. Advancing the understanding of the arterial anatomy supplying the PTN and its branches may provide insight into the cause and treatment of tarsal tunnel syndrome.

Results of surgical treatment of tarsal tunnel syndrome.

The aim of our study is to evaluate retrospectively the prognostic factors affecting the final outcome of surgical treatment of tarsal tunnel syndrome. Surgical decompression were performed on 31 patients. All patients had EMG and anesthetic test confirmation. The results were evaluated according to VAS scale and modified AOFAS score. Follow-up was after 12 months. 22 patients received very good or good (71%), 7 satisfactory (22%), 2 poor (7%) results in the subjective and objective patient's assessment. The outcomes decreased from 5.19 (SD 1.01) points to 1.19 (SD 0.83) points according to VAS scale, and modified AOFAS increased from 31.77 (SD 9.08) points to 57.58 (SD 9.90). Patients with diagnosed cause, short period of time between onset of disease till surgery, and positive Tinel's sign achieved the best results. Etiology of the tarsal tunnel syndrome has influence on the results. Immediate diagnosis and short period between occurrences of symptoms in surgical treatment improves the outcomes. Tinel's sign may be used as a prognostic factor.

The Scratch Collapse Test Supported the Diagnosis and Showed Successful Treatment of Tarsal Tunnel Syndrome

We describe a case where the scratch collapse test was found positive for tarsal tunnel syndrome and negative after successful surgery in a female patient.