Plantar Fascia Release With Proximal and Distal Tarsal Tunnel Release: A Surgical Approach to Chronic, Disabling Plantar Fasciitis With Associated Nerve Pain

Neurolysis for Failed Tarsal Tunnel Surgery

“…The outcomes of TTR have varied, with failure rates of 4% to 56% reported (1,2,4,7), particularly in patients in whom a specific etiology could not be identified (10). We believe that these rates do not always reflect the "true" failure rate, because many studies have been of varieties of surgical release, including extensile release (11), the 4-medial ankle tunnel release (tibialis posterior, medial and lateral plantar nerves, and calcaneal nerve) (1,3,7,12,13), proximal-only TTR (2,3), distal-only TTR (6,14), selective nerve release (2,4,6,15), and shorter incisions (16). Again, only a few studies have been published and have included small numbers of patients with failed TTR, variable results, and a wide range of surgical procedures (4).…”

“…Throughout the published data, reports have been made of the variable outcomes of tarsal tunnel release (TTR) (2,4,5). The failure rate of TTR has ranged from 4% to 56% (1,2,6,7).…”

“…The most common causes have been associated space-occupying lesions in the tarsal tunnel, in which case TTR alone will not suffice. However, many of the failures have resulted from a lack of appreciation of the involved anatomy or from an inadequate technique (1,2,4,6), with insufficient TTR a frequent error. The wide variation in the success rate has also resulted from patient selection and the timing of the surgical intervention.…”

Recent updates in the management of plantar fasciitis

“…27,29 To improve outcomes in patients with chronic, debilitating plantar fasciitis, the authors employ a comprehensive operative approach that treats all potential pathologies. After preoperative evaluation of patients with chronic plantar fasciitis, the authors have noted a likely biomechanical incompetence of a significant portion of the plantar fascia, and it is often associated with nerve entrapment.…”

“…After preoperative evaluation of patients with chronic plantar fasciitis, the authors have noted a likely biomechanical incompetence of a significant portion of the plantar fascia, and it is often associated with nerve entrapment. 29 In this challenging group of patients with chronically attenuated plantar fascia and associated nerve entrapment, the authors have found an operative technique using a complete plantar fascia release with release of the proximal and distal tarsal tunnel to be an effective approach. In a retrospective series, more than 75% of such patients undergoing primary surgery were satisfied and had improved function after the suggested treatment.…”