Tarsal tunnel syndrome – the effect of the associated features on outcome of surgery

Abstract

Between 1989 and 2000, 16 patients underwent surgery for tarsal tunnel syndrome; 12 patients (13 feet) were available for follow-up at a mean of 83 (12-143) months. The symptoms had resolved in six feet, were improved in four, were unchanged in two and recurred after five years in one. Better results are obtained in patients who have space occupying lesions than in those in whom the aetiology is idiopathic or post-traumatic or those with foot deformities.Résumé Entre 1989 et 2000 nous avons traité chirurgicalement 16 malades présentant un syndrome du tunnel tarsien. Chez 12 malades (13 pieds) les résultats ont été évalués après une moyenne de 83 (12-143) mois. Pour six pieds les symptômes avaient complètement disparus, pour quatre pieds les symptômes ont été améliorés, deux pieds ont été inchangés et dans un cas les symptômes sont revenus après 60 mois. Le résultat du traitement chirurgical est meilleur chez les patients avec des lésions l'espace occupante. IntroductionTarsal tunnel syndrome (TTS) is an entrapment neuropathy of the posterior tibial nerve and its branches within the tunnel formed by the flexor retinaculum. It was first described by Kopell and Thompson [11] in 1960. The term "Tarsal Tunnel Syndrome" was first used independently by Keck [10] and Lam [12] in 1962. The syndrome may be idiopathic or secondary to direct pressure from space-occupying lesions, adhesions following trauma, inflammatory causes or deformities of the foot [1,2,21,24,26,28,30].Onset of symptoms is usually insidious. Patients usually complain of burning pain and numbness, especially on the medial plantar aspect of the foot, in the area served by the affected nerve [18,30]. Tinel's sign is usually positive [3,20,27]. There may be night pain and cramps in the longitudinal arch. Symptoms are related to exercise and maximal at the end of the day [14,21,30]. Diagnosis is made from the history, physical examination and nerve conduction studies. Normal nerve conduction studies, however, may not exclude an entrapment neuropathy [5,7,9,19,22]. In this study, we aimed to assess the factors that affect the outcomes of surgically treated TTS patients, such as different aetiologies, duration of symptoms etc.. Patients and methodsOf 16 patients with TTS who underwent surgery, 12, (13 feet) were available for review at a mean follow-up of 83 (12-143) months. There were nine women and three men, with a mean age of 39.5 (25-57) years and a mean duration of symptoms of 31.9 (2-240) months. In six patients the right foot was involved, five the left and both in one. Tinel's sign was positive pre-operatively in 12 feet and doubtful in one. All pre-operative EMGs, except for one, were consistent with a diagnosis of TTS. The findings were positive for the medial plantar nerve in four feet and for both plantar nerves in eight. There were significant foot deformities in five cases, three of which had pes planus, one splayfoot and one calcaneal fracture. Atrophy and weakness of the plantar muscles was found in one case, whose symptoms were c...

Potential sites of compression of tibial nerve branches in foot: A cadaveric and imaging study

“…All the 120 patients were requested to detail their complaints for which they were referred to the Department of Radiology and it was observed that 48 patients presented with symptoms suggestive of nerve compression in the foot (Table ). Motor deficits in the form of weakness or atrophy of the intrinsic foot muscles were uncommon in these patients as have been noted in the previous studies (Erickson et al, ; Llanos et al, ; Urguden et al, ). Ultrasonography of the ankle and sole region identified the abductor hallucis muscle as the cause of compression neuropathy of the tibial nerve branches in the foot of three patients, who had presented with neurological symptoms.…”

Value of motor nerve conduction studies in the diagnosis of idiopathic tarsal tunnel syndrome: A single-center prospective observational study from India

“…studied 13, 8, and 21 patients of s TTS, respectively, and did not find bilateral symptoms in anyone. [ 3 16 31 ] An and Kim et al . reported bilateral i TTS in 12 of their 21 patients and concluded that bilateral i TTS were more common in their study.…”

“…Although Tinel's sign is considered to be an important physical sign of TTS, it is not consistently present in all the patients. The surgically oriented studies of s TTS[ 12 17 31 ] and i TTS[ 32 ] report it to be present in 90%–100% the cases, in contrast, a medically oriented retrospective study of i TTS has reported this sign in 51% feet. [ 18 ] In our prospective study, we found Tinel's sign to be present only in 7.5% of symptomatic limbs.…”

Tarsal Tunnel Surgery Secondary to a Tarsal Ganglion

“…Surgical outcomes for patients with ganglions or any other cystic masses in the tarsal tunnel are often good. [12][13][14] Tarsal tunnel surgery complicated with a ganglion or any other type of cystic mass can be a very challenging operation. This type of surgery requires a bloodless field using a tourniquet, loupe magnification (see Figure 9), bipolar coagulation (see Figure 10), and most likely an intraoperative electrical stimulation of the nerve, even if it is performed using only a disposable, battery-operated device.…”