Neurolysis for Failed Tarsal Tunnel Surgery

Yalçınkaya, Merter; Ozer, Utku Erdem; Yalçın, Mehmet Burak; Bagatur, A. Erdem

doi:10.1053/j.jfas.2014.05.012

Cited by 8 publications

(5 citation statements)

References 25 publications

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“…In the cases that produced poor results, an MRI scan was performed to assess whether there was postoperative fibrosis. Unlike open surgery, ultrasound-guided surgery did not show any signs of significant postoperative fibrosis, which can produce poor results [24,25]. Similarly, our review did not reveal any problems related to dehiscence, poor healing, or complex regional pain syndrome, which is a major advantage of using the ultrasound-guided surgical technique for patients with venous insufficiency, diabetes, and other diseases that can delay healing.…”

Section: Discussionmentioning

confidence: 56%

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Results of ultrasound-guided release of tarsal tunnel syndrome: a review of 81 cases with a minimum follow-up of 18 months

Iborra¹,

Villanueva²,

Sanz-Ruíz³

2020

J Orthop Surg Res

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Background: This study aims to analyse the clinical results of ultrasound-guided surgery for the decompression of the tibial nerve, including its distal medial and lateral branches, to treat tarsal tunnel syndrome. These structures are the complete flexor retinaculum and the deep fascia of the abductor hallucis muscle, including individualised release of the medial and lateral plantar nerve tunnels. Method: This is a retrospective review of 81 patients (36 men and 45 women) with an average age of 41 years old (32-62) and an average clinical course of 31 months (8-96) compatible with idiopathic tarsal tunnel syndrome, who underwent ultrasound-guided decompression of the proximal and distal tarsal tunnel between February 2015 and November 2017 (both months included), with a minimum follow-up of 18 months. Results: Based on the Takakura et al. scale for the 81 patients, 76.54% obtained excellent results, 13.58% good results, and 9.87% poor results. The patients with the longest course of symptoms displayed the worst results. Conclusion: Although 9% of patients did not improve, ultrasound-guided tarsal tunnel release might be a viable alternative to conventional open approaches.

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Section: Discussionmentioning

confidence: 56%

“…This might represent a limitation in our ultrasoundguided surgical technique; however, the results are comparable to those obtained by other authors. In our practice, we reserve septum excision, associated with internal neurolysis of the nerves, for patients with poor results following ultrasound-guided release [24].…”

Section: Discussionmentioning

confidence: 99%

Results of ultrasound-guided release of tarsal tunnel syndrome: a review of 81 cases with a minimum follow-up of 18 months

Iborra¹,

Villanueva²,

Sanz-Ruíz³

2020

J Orthop Surg Res

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“…This is important to note as the tarsal tunnel itself is complex and because the FR is not the only etiology known to cause TTS. Clinically, many patients with TTS may continue to have pain despite release of the FR ( 26 , 27 ).…”

Section: Discussionmentioning

confidence: 99%

Safety and efficacy of ultrasound-guided percutaneous flexor retinaculum release of the ankle: an anatomical study

Sun,

Shi,

Shen

et al. 2024

Quant Imaging Med Surg

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Background Tarsal tunnel syndrome (TTS) is a condition in which the tibial nerve (TN) (or its terminal branches) is compressed by the flexor retinaculum (FR) and the deep fascia of the abductor hallucis muscle at the tarsal tunnel, causing symptoms that negatively impact the patient’s quality of life, including numbness, a sensation of a foreign object, coldness, and pain. FR release via microtrauma using needle-knife has proven to be effective in China and is widely used by clinicians. The traditional acupotomy, however, is the “blind knife” treatment, which cannot guarantee patient safety due to risk of injury to important structures, particularly the neurovascular bundle. Compared with the conventional treatments, ultrasound-guided percutaneous FR release possesses noteworthy advantages including high efficacy and safety. Methods Percutaneous release of the FR was performed on 51 formalin-fixed specimens. The specimens were divided into two groups: an ultrasound-guided acupotomy pushing group comprising 20 legs (group U) and a nonultrasound-guided acupotomy pushing group comprising 31 legs (group N). After high-frequency ultrasound exploration, those with clear vascular imaging were included in group U; otherwise, they were included in group N. The FR was released percutaneously, soft tissue was dissected layer by layer, and anatomical data were recorded. Results There no cases of injury in group U (0%) and four in group N (12.9%). Among the different intervention methods, there were no significant differences in tissue injury types (χ 2 =2.80; P=0.09). The percentage of released FR in group U was 80.00% while that in group N was 61.29% (χ 2 =1.977; P=0.16), which did not represent a significant difference between the two groups. However, group U had a significantly greater release length than that in the group N ( t =3.359; P=0.002), indicating that the flexor release length guided by ultrasound is significantly greater than the unguided one. Conclusions Ultrasound-guided percutaneous release of the FR using a needle-knife can provide greater length and percentage of released FR while maintaining a comparable safety rate to the unguided procedure.

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“… 1 , 9 , 10 , 12 , 21 , 22 ) The rate is affected by factors such as patient selection, symptom duration, electrophysiological findings, diagnostic inaccuracy, surgical technique, and the postoperative follow-up period. 1 , 9 , 10 , 12 , 23 , 24 ) Others 25 , 26 ) reported that surgical treatment failure was due to inadequate knowledge of the involved anatomy or incomplete surgical release.…”

Section: Discussionmentioning

confidence: 99%

Magnetic Resonance Imaging Findings in Patients with Tarsal Tunnel Syndrome

Kim

Kokubo

Isu

et al. 2022

Neurol. Med. Chir.(Tokyo)

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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.

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Neurolysis for Failed Tarsal Tunnel Surgery

Cited by 8 publications

References 25 publications

Results of ultrasound-guided release of tarsal tunnel syndrome: a review of 81 cases with a minimum follow-up of 18 months

Results of ultrasound-guided release of tarsal tunnel syndrome: a review of 81 cases with a minimum follow-up of 18 months

Safety and efficacy of ultrasound-guided percutaneous flexor retinaculum release of the ankle: an anatomical study

Magnetic Resonance Imaging Findings in Patients with Tarsal Tunnel Syndrome

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