Abstract:The results of postoperative increase in PtcO2 values demonstrate that the release of the tarsal tunnel determines a relevant increase in microcirculation in the feet of diabetic patients.
“…Therefore, US‐guided tarsal tunnel release is feasible, as the surgeon can visualize the main structures involved. The goal of this study was to investigate the efficacy and safety of US‐guided tarsal tunnel release …”
Objectives
The purpose of the study was to determine whether ultrasound (US)‐guided surgery is a viable type of surgery for performing an effective release/decompression of the constricting structures that are responsible for focal nerve compression in tarsal tunnel syndrome.
Methods
Ultrasound guidance was used on cadaveric specimens to delineate the anatomic course of the nerves and vessels in the medial ankle that comprise the structures involved in tarsal tunnel syndrome. Ultrasound guidance was used on cadaveric specimens and assisted in delineating a safe surgical zone to adequately and effectively release these constrictive structures of the proximal and distal tarsal tunnels. The US‐guided tarsal tunnel release/decompression was performed through 2 small 1‐ to 2‐mm portals. After US‐guided release, anatomic dissection was used to check the efficacy (release of the flexor retinaculum and deep abductor hallucis muscle) and safety (absence of neurovascular or tendon injury) of the procedure.
Results
In 12 fresh cadaveric specimens, US‐guided release of the tibial nerve (proximal tarsal tunnel) and its branches (distal tarsal tunnel) at the medial ankle was effective in all 12 specimens (100% release rate), without any signs of compromise or injury into the neurovascular structures.
Conclusions
Ultrasound‐guided tarsal tunnel release is a feasible surgical procedure that can be safe and effective with the proper training, although further investigation is warranted. This type of surgery may promote faster recovery with less postoperative morbidity, including pain, but this will be the subject of a further investigation.
“…Therefore, US‐guided tarsal tunnel release is feasible, as the surgeon can visualize the main structures involved. The goal of this study was to investigate the efficacy and safety of US‐guided tarsal tunnel release …”
Objectives
The purpose of the study was to determine whether ultrasound (US)‐guided surgery is a viable type of surgery for performing an effective release/decompression of the constricting structures that are responsible for focal nerve compression in tarsal tunnel syndrome.
Methods
Ultrasound guidance was used on cadaveric specimens to delineate the anatomic course of the nerves and vessels in the medial ankle that comprise the structures involved in tarsal tunnel syndrome. Ultrasound guidance was used on cadaveric specimens and assisted in delineating a safe surgical zone to adequately and effectively release these constrictive structures of the proximal and distal tarsal tunnels. The US‐guided tarsal tunnel release/decompression was performed through 2 small 1‐ to 2‐mm portals. After US‐guided release, anatomic dissection was used to check the efficacy (release of the flexor retinaculum and deep abductor hallucis muscle) and safety (absence of neurovascular or tendon injury) of the procedure.
Results
In 12 fresh cadaveric specimens, US‐guided release of the tibial nerve (proximal tarsal tunnel) and its branches (distal tarsal tunnel) at the medial ankle was effective in all 12 specimens (100% release rate), without any signs of compromise or injury into the neurovascular structures.
Conclusions
Ultrasound‐guided tarsal tunnel release is a feasible surgical procedure that can be safe and effective with the proper training, although further investigation is warranted. This type of surgery may promote faster recovery with less postoperative morbidity, including pain, but this will be the subject of a further investigation.
“…Trignano et al [52] reported 100% healing and 0/8 recurrences of neuro-ischemic DFU at 18 months after ND.Figure 3.A Kaplan Meier survival curve illustrates the ulcer-free survival of 42 cases with prior healed unilateral DFU and subsequent ND of that leg only. The previously intact contralateral leg, without ND, has a relative risk of subsequent ulceration of 5.5 ( p = 0.048).…”
Section: Objective Outcomesmentioning
confidence: 99%
“…Trignano et al [52] found 40 diabetic feet with ischemic levels of transcutaneous skin oxygenation (TcpO2) below 40 mm Hg had returned to levels above 40 after ND in 90% of cases by month 3 and 95% by 18 months. Nominal improvement occurred in 100%.…”
Section: Objective Outcomesmentioning
confidence: 99%
“…Hyperspectral imaging technology exists to prospectively identify advanced DSPN cases who will soon develop an ulceration, offering the prospect of further savings by using ND to avoid the primary DFU [59]. Raising TcpO2 in neuro-ischemic situations suggests further opportunity for avoiding DFU cases and costs [52]. …”
External neurolysis of the nerve at fibro-osseous tunnels has been proprosed to treat or prevent signs, symptoms, and complications in the lower extremity of diabetes patients with sensorimotor polyneuropathy. Nerve decompression is justified in the presence of symptomatic compressed nerves in the several fibro-osseous tunnels of the extremities, which are known to be frequent in diabetes. Quite a body of literature has accumulated reporting results after such nerve decompression in the leg, describing pain relief and sensibility improvement, as well as balance recovery, diabetic foot ulcer prevention, curtailed ulcer recurrence risk, and amputation avoidance.Historical academic hesitance to endorse surgical treatments for pain and numbness in diabetes was based primarily on the early retrospective reports’ potential for bias and placebo effects, and that the hypothetical basis for surgery lies outside the traditional etiology paradigm of length-dependent axonopathy. This reticence is here critiqued in view of recent studies using objective, measured outcome protocols which nullify such potential confounders. Pain relief is now confirmed with Level 1 studies, and Level 2 prospective information suggests protection from initial diabetic foot ulceration and most neuropathic ulcer recurrences. In view of the potential for nerve decompression to be useful in addressing some of the more difficult, expensive, and life altering complications of diabetic neuropathy, this secondary compression thesis and operative treatment methodology may deserve reassessment.
“…Ischemia of the extremity as a result of atherosclerosis and diabetic vasculopathy, and diabetic peripheral neuropathy are main causes of diabetic foot ulcers . In various studies diabetic peripheral neuropathy is considered to be the main reason in the formation on diabetic foot ulcers …”
According to these results, it can be suggested that the nerve release procedures have a positive effect on the hemodynamic and morphological parameters of the arteries as they pass through the anatomical tunnels as well as its positive effects on the neurological functions of the entrapped nerves.
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