Ultrasound-guided decompression surgery of the tarsal tunnel: a novel technique for the proximal tarsal tunnel syndrome—Part II

Abstract

Background The aim of this study is to provide a safe ultrasound-guided minimally invasive surgical approach for a proximal tarsal tunnel release concerning nerve entrapments. Methods and results The study was carried out on ten fresh-frozen feet. All of them were examined by high resolution ultrasound at the medial ankle region. The surgical approach was marked throughout the course of the flexor retinaculum (laciniate ligament). Once the previous steps were done, the flexor retinaculum release technique was carried out with a 2-mm entry only. As a result, an effective and safe release of the flexor retinaculum was obtained in all fresh-frozen feet. Conclusion The results of our anatomic study indicate that our novel ultrasound-guided minimally invasive surgical approach for the release of the flexor retinaculum might be an effective, safe and quick decompression technique treating selected patients with a proximal tarsal tunnel syndrome.

Anatomical basis of a safe mini-invasive technique for lengthening of the anterior gastrocnemius aponeurosis

“…Performing our novel US-guided GIAR the entry portal at the interval between the gastrocnemius and soleus muscle, the preservation of the saphenous nerve and the greater saphenous vein are ensured due to the direct visualization by ultrasound. Using the same surgical materials as for the ultrasound-guided tarsal tunnel release, previously described by our group [ 13 , 21 , 22 ], the small surgical portal (2 mm mean), might lead to better cosmetical results if compared to the endoscopic GIAR [ 19 ]. Ultrasound-guided surgery has a major advantage with respect to open or endoscopic procedures because it might be performed without hemostasis, less post-operative pain and leads to less post-operatives complications [ 13 , 21 ].…”

Peripheral Nerve Anatomy Revisited: Modern Requirements for Neuroimaging and Microsurgery

“…Macroscopic anatomic research itself is often criticized for not providing novel scientific results (Mazurek and Shin, ; Lippert, ). In contrast, over the years, a number of scientific questions concerning clinical and applied peripheral nerve anatomy have been raised and addressed with direct benefit for the patient (Eichenberger et al, ; Dralle et al, ; Konschake and Fritsch, ; Konschake et al, ; Konschake et al, ; Fernández‐Gibello et al, ; Konschake, ; Moroni et al, ). For example, the inferior laryngeal nerve (ILN) in endocrine surgery (Chiang et al, ; Konschake et al, ; Randolph and Kamani, ) and peripheral nerves of the head and neck in migraine surgery (supraorbital, supratrochlear, auriculotemporal, zygomaticotemporal, and occipital) have been in the focus of several studies (Mosser et al, ; Guyuron et al, ; Totonchi et al, ; Janis et al, , et al; Caruana et al, ; Berchtold et al, ; Gfrerer and Guyuron, ).…”

High Volume Injection (Hydrodissection) for Tarsal Tunnel Syndrome Using Peripheral Nerve Stimulation: Treatment Protocol

“…Figure 1: TTS injection (Reilly, 2010) The basic technique of hydrodissection (high volume injection [HVI]) includes identifying the region of nerve entrapment or compression and the use of a fluid medium, usually local anaesthetic and/or saline, to dissect between structures or fascial planes (Beard & Gousse, 2018;Cass, 2016;Delzell & Patel, 2020;Lam et al, 2020). Pathological nerves can be identified by examination or ultrasound visualisation (Fernández-Gibello, 2019). Our team performs palpation-guided, ultrasound-guided and nerve stimulator-guided blocks for regional anaesthesia.…”