Magnetic Resonance Imaging Findings in Patients with Tarsal Tunnel Syndrome

Abstract

Tarsal tunnel syndrome (TTS) is a common entrapment syndrome whose diagnosis can be difficult. We compared preoperative magnetic resonance imaging (MRI) and operative findings in 23 consecutive TTS patients (28 sides) whose mean age was 74.5 years. The 1.5T MRI sequence was 3D T2* fat suppression. We compared the MRI findings with surgical records and intraoperative videos to evaluate them. MRI-and surgical findings revealed that a ganglion was involved on one side (3.6%), and the other 27 sides were diagnosed with idiopathic TTS. MRI visualized the nerve compression point on 23 sides (82.1%) but failed to reveal details required for surgical planning. During surgery of the other five sides (17.9%), three involved varices, and on one side each, there was connective tissue entrapment or nerve compression due to small vascular branch strangulation. MRI studies were useful for nerve compression due to a mass lesion or idiopathic factors. Although MRI revealed the compression site, it failed to identify the specific involvement of varices and small vessel branches and the presence of connective tissue entrapment.

Impact of Dynamic Change of Meandering of Parallel Artery to the Idiopathic Tarsal Tunnel Syndrome

“…Regarding how much meandering results in symptoms, several elements, including traction by arterial branches, arterial stiffness, and thickness of the flexor retinaculum/neurovascular band, may be connected. In a study of surgical cases, 18 ) there was evident nerve compression by arterial meandering even in the neutral ankle position. It is hypothesized that worsening nerve compression brought on by increased arterial meandering in connection with ankle mobility under this circumstance may have an impact on the onset of symptoms.…”

“…The MR imaging of the TT was performed using Ingenia 1.5T MRI (Philips Japan, Ltd.) with the head/neck coil. The sequence of the MRI was T2* fat suppression 3D (TR, 21.8 msec; TE, 13.8 msec; slice, 1.6 mm; matrix, 208 × 208; FOV, 12 cm) 17 , 18 ) and MRA. About the MRA imaging, the blood flow is weak in the TT, and it was challenging to see the blood flow using the “time of flight” method, which is typically used for intracranial MRA.…”

“…MRI is helpful to rule out mass lesion, but it is also useful to show the compression to the nerve. 17 , 18 ) We focus on the worsening of the symptom of the TTS by the ankle movement, and we examined the change of the nerve compression caused by the surrounding tissue, including posterior tibial artery, with the ankle movement using dynamic MR image and operation results.…”

Patient Satisfaction with Surgery for Tarsal- and Carpal- Tunnel Syndrome - Comparative Study

“…Symptomatic TTS can be due to space-occupying lesions such as ganglia or schwannoma; it can be diagnosed by MRI and high-resolution ultrasound, [5][6][7][8][9][10] and the surgical results are relatively good. 5,[11][12][13] Idiopathic TTS is elicited by physiological changes such as adhesions due to trauma, distortion of an artery, dilation of a vein, or hypertrophy of the flexor retinaculum.…”

“…5,[11][12][13] Idiopathic TTS is elicited by physiological changes such as adhesions due to trauma, distortion of an artery, dilation of a vein, or hypertrophy of the flexor retinaculum. 1,2,5,10) Currently there is no gold-standard examination for idiopathic TTS. Because the results of electrophysiologic examination are not reliable, 1,11,[14][15][16][17][18] and because its diagnosis tends to be based on clinical findings, 5,[14][15][16] the postoperative outcome may be unsatisfactory.…”