Ultrasound-Guided Proximal and Distal Tarsal Decompression: An Analysis of Pressures in the Tarsal, Medial Plantar, and Lateral Plantar Tunnels

Abstract

Objectives. To analyze the reliability of measurements of tarsal tunnel and medial and lateral plantar tunnel pressures before and after ultrasound-guided release. Measurements taken were guided by ultrasound to improve reliability. This novel approach may help surgeons make surgical decisions. The second objective was to confirm that decompression using ultrasound-guided surgery as previously described by the authors is technically effective, reducing pressure to the tarsal and medial and lateral plantar tunnels. Methods. The study included 23 patients with symptoms compatible with idiopathic tarsal tunnel syndrome (TTS). The first step was to measure intracompartmental pressure of the tarsal tunnel, medial plantar tunnel, and lateral plantar tunnel preoperatively. The second step was ultrasound-guided decompression of the tibial nerve and its branches. Subsequently, pressure was measured again immediately after decompression in the 3 tunnels. Results. After surgery, the mean values significantly dropped to normal values. This represents a validation of effective decompression of the tibial nerve and its branches in TTS with ultra–minimally invasive surgery. Conclusions. The ultrasound-guided surgical technique to release the tibial nerve and its branches is effective, significantly reducing pressure in the tunnels and, thereby, decompressing the nerves. Level of evidence: Level IV

Clinical Results Following Conservative Management of Tarsal Tunnel Syndrome Compared With Surgical Treatment: A Systematic Review

“…31,35 Ultrasound can be useful to assess for space occupying lesions and assessing the anatomy of the patient and can also asses for pressures within the tarsal tunnel. [38][39][40] MRI is useful for treatment planning in addition to assessing for space occupying lesions that could be causing the TTS. 32,35,39 MRI in patients with TTS will show an abnormality in 85% of patients and can thus be a useful diagnostic tool.…”

Tarsal tunnel syndrome: current rationale, indications and results

“…The diagnosis is usually made by correlating clinical history, imaging tests and nerve conduction studies (NCSs) / electromyography (EMG). 4 , 2 , 37 , 38…”

“…Measurement of the pressure in the tarsal tunnel below the flexor retinaculum and medial and lateral plantar tunnels, under the abductor hallucis, could make a reliable diagnosis of TTS. 4 In living patients, Kumar et al 43 measured the pressure in the tarsal tunnel compartment in the neutral position and with plantar and dorsal flexion of the ankle using a water manometer. The values obtained were 4 to 7 mm Hg, 10 to 15 mm Hg and 15 to 20 mm Hg, respectively.…”

“…Tarsal tunnel syndrome (TTS), first defined in 1962 by Keck 1 and Lam 2 , is a compressive peripheral neuropathy of the posterior tibial nerve and its branches within the tarsal tunnel beneath the flexor retinaculum. 3 , 4 The prevalence of TTS is low relative to other compressive neuropathies, although it is often underdiagnosed and even misdiagnosed as plantar fasciitis. 1 , 4 , 5 …”

“… 3 , 4 The prevalence of TTS is low relative to other compressive neuropathies, although it is often underdiagnosed and even misdiagnosed as plantar fasciitis. 1 , 4 , 5 …”