Pulsed radiofrequency under ultrasound guidance for the tarsal tunnel syndrome: two case reports

Abstract

Tarsal tunnel syndrome (TTS) is a compression neuropathy that results from entrapment of the posterior tibial nerve or its branches. TTS may be treated either by conservative measures, including physical therapy, medications, and steroid injections, or by surgical decompression. Despite a variety of treatments, a few cases of TTS will relapse, and many cases of recurrent TTS will require re-operation. Pulsed radiofrequency (PRF) is known to have a number of advantages for pain management, particularly as this technique does not cause neural compromise such as motor weakness. Here, we report a new application of ultrasound-guided PRF in two cases of intractable TTS. Both patients had a long duration of severe foot pain and had been treated with various therapeutic modalities without lasting relief. We applied ultrasound-guided PRF to the affected posterior tibial nerve in each patient, and both had significantly reduced pain intensity scores and analgesic requirements without any complications. Ultrasound-guided PRF for intractable TTS relieved severe foot pain. It may supersede surgery as a reliable treatment for intractable TTS.

Ultrasound‐Guided Release of the Tibial Nerve and Its Distal Branches: A Cadaveric Study

“…Ultrasound‐guided surgery is performed with 1‐ to 2‐mm incisions, without ischemia, and with local anesthesia as an outpatient surgery. It may provide more aesthetically pleasing scars and facilitate recovery, thus reducing the risk of infection, wound dehiscence, and postoperative perineural fibrosis …”

“…Tarsal tunnel syndrome (TTS) is a compression neuropathy that results from entrapment of the posterior tibial nerve (TN) and its branches . The proximal part of the posterior TN can be entrapped behind the medial malleolus by the laciniate ligament or flexor retinaculum (formed by the deep and superficial fascias of the leg and closely attached to the flexor sheaths of the posterior tibial, flexor digitorum, and flexor hallucis tendons).…”

“…7 Tarsal tunnel syndrome (TTS) is a compression neuropathy that results from entrapment of the posterior tibial nerve (TN) and its branches. 8,9 The proximal part of the posterior TN can be entrapped behind the medial malleolus by the laciniate ligament or flexor retinaculum (formed by the deep and superficial fascias of the leg and closely attached to the flexor sheaths of the posterior tibial, flexor digitorum, and flexor hallucis tendons). Heimkes et al 10 and other authors reported that other sites of entrapment were actually occurring beneath the deep fascia of the abductor hallucis muscle (AHM), which forms the medial plantar nerve (MPN) and lateral plantar nerve (LPN) tunnels, or the distal tarsal tunnel, in opposition to the proximal flexor retinaculum or the proximal tarsal tunnel.…”

Application of Radiofrequency in Pain Management

“…Protect motor fibers! Also, pulsed RF are reported in the literature that it can be used in treatment of Morton's neuroma [13], coccygodynia [14], pudendal neuralgia [75], vaginismus [76], carpal tunnel syndrome [77], chronic hip pain [78], post herniorrhaphy pain [79], chronic inguinal neuralgia [80], plantar heel pain [81], osteoarthritis [82], intra-articular pain [83], plantar fascitis pain [84], tarsal tunnel syndrome [85], myofascial pain syndrome [86], postamputation phantom pain [87], meralgia paresthetica [88], lingual neuralgia [89] and chronic testicular pain [90].…”

Sonographie peripherer Nerven

“…Der Ultraschall eignet sich teilweise auch zur Behandlung von Kompressionssyndromen (ultraschallgestützte Blockaden mit Lokalanästhetika und Kortison) und weist dabei eine höhere Blockerfolgsrate mit weniger Nebenwirkungen (z.B. Blutungen) auf[1,12,13,19,38,56,58,63].Abbildung 3. Verschiedene Pathologien.…”