Management of tarsal tunnel syndrome: report of seven cases

Abstract

SUMMARY -Seven patient s wit h clinica l an d electroneurographic evidenc e of tarsal tunne l syndrom e wer e managed surgically, after failed attempts for non-surgical treatment. Post-operative results were more satisfactory than th e previous response s t o non-surgical therapies . Tarsa l tunne l syndrome appear s t o respond bette r to surgical intervention than to conservative management .KEY WORDS: tarsal tunnel, posterior tibial nerve, tibial nerve compression, surgical decompression .Tratamento da síndrome do túnel do tarso: relato de sete casos RESUMO -Sete paciente s co m evidência clínic a e eletroneurográfica de síndrome d o túnel d o tarso fora m tratadas cirurgicamente, após tentativas sem sucesso de tratamento não cirúrgico. Os resultados pós-operatório s foram bem mais satisfatórios que as tentativas prévias com terapêuticas não cirúrgicas. A síndrome do túnel do tarso parece responder melhor à abordagem cirúrgica do que a condutas mais conservadoras .PALAVRAS-CHAVE: túnel do tarso, nervo tibial posterior, compressão do nervo tibial, descompressão cirúrgica.Tarsal tunnel syndrome is a well known entity. Studies have described this illness in patients with neurological an d electroneurographic evidenc e of posterior tibial nerve compression 3 8 1 0 .From the pertinent literature, there seems t o be agreemen t tha t this syndrome constitute s a disorder primarily amenable to surgical intervention. The present work was carried out in a series of seven prospectively observed patients, in whom clinical management was unsatisfactory. The latter consisted of systemic administration of non-steroid anti-inflammatory agents, local steroid infiltrations, and a variety of podiatric procedures. Patients eventually underwent surgical decompression of the posterior tibial nerve within the tarsal tunnel. CASE REPORTSCase 1 . A 43-year-old woma n presente d wit h a 12-yea r histor y o f progressive burnin g pai n ove r the postero-lateral aspec t o f the right leg , irradiated t o the medial an d plantar region s o f the right foot . Thes e symptoms were exacerbated o n the upright position, and while deambulating. Relief was achieved during rest. Neurological examination disclosed mild deficit on plantar flexion of the right foot and hallux with hypoesthesia on the medial and dorsal aspects of the right foot. Painfu l symptom s could be triggered by pressure applied to the medial retromalleolar region. Electroneurographic testing revealed marked slowness in neuroconduction of the dista l segment s o f both posterio r tibia l nerves , mor e pronounce d o f the right side . Thes e abnormalitie

Surgical Treatment of Tarsal Tunnel Syndrome - Case Report

“…This is comparable to the observations of Valtin [2] who recommends a nervous release beyond the division of the nerve and in all cases the deep fascia of the hallux abductor must be incised and insists that this must be the case in any compression of the tibial nerve or one of its branches of division. This recommendation is also taken up by Skalley et al [3] in their study of 12 cases, similarly in the study of Settanni et al [4]. Early diagnosis is important because the resulting surgical management guarantees the best results.…”

Surgical Treatment Compared to Conservative Treatment in Remission of Pain and Hyposthesia in Tarsal Tunnel Syndrome – Systematic Review

“…After the pulsed radiofrequency, the patients were followed for a period of 8 to 12 months, with good response (control of pain and reduction of hypoesthesia). 9 11…”

“…We identified a rate of good or excellent pain control of 68% (n = 204) for open surgery (n = 299), 100% (n = 8) for endoscopic surgery (n = 8), and 7% (n = 2) for conservative treatment (n = 28). 5 6 7 8 9 10 12 13 14 15…”

“…Many causes can contribute to the onset of the disease: fractures or dislocations involving the talus, calcaneus or medial malleolus, ganglion cysts, tumors, hypothyroidism, and inflammatory causes, such as rheumatoid arthritis and diabetes mellitus. 3 5 6 7 8 9 10…”

Resultados do tratamento cirúrgico da síndrome do túnel do tarso posterior idiopática

“…O tratamento recomendado inicialmente é o conservador, orientando-se repouso, fi sioterapia e uso de analgésicos orais. Nos casos em que não há resposta clínica a essas manobras, recomenda-se o tratamento cirúrgico 18 . O objetivo deste trabalho é demonstrar os resultados obtidos com o tratamento cirúrgico desta entidade clínica, com a identifi cação dos potenciais benefícios e riscos do procedimento, para os casos em que são excluí-dos fatores secundários como causa dos sintomas.…”