Vascular Wrapping using the Flexor Retinaculm as a New Method for the Tarsal Tunnel Syndrome

Abstract

In tarsal tunnel syndrome, vascular compression beneath the flexor retinaculum has been suggested as one of the causes of nerve insult. We have attempted reconstruction of the tunnel after transposition of the vasculature from the tunnel. However, among 205 lesions with tarsal tunnel syndrome surgically treated using such a reconstruction method, we experienced 6 recurrences. Adhesion and compression by granulation in the reconstructed tarsal tunnel was a common finding. To avoid this, we designed a new method. After the flexor retinaculum is incised slightly to the medial side of the tunnel, the posterior tibial artery and the medial and lateral plantar veins vascular complex are detached from the medial and lateral plantar nerve. The vascular complex is then relocated from the tunnel and wrapped with the flexor retinaculum laterally outside the tunnel. This method may be more effective than preexisting ones. Long term efficacy of our method is to be proved in accumulation of experiences.

Impact of Dynamic Change of Meandering of Parallel Artery to the Idiopathic Tarsal Tunnel Syndrome

“…In light of numerous prior reports suggesting that decompression of posterior tibial artery is important in TTS surgery, 2 , 4 , 7 , 16 ) our findings may be justified. However, since this study has a small sample size, our results do not demonstrate that the posterior tibial artery may be the main compression cause in all idiopathic TTS.…”

“…These nerves are located in the same compartment with the posterior tibial artery and vein by the neurovascular band, and the nerve is required to release from posterior tibial artery (neurovascular decompression). 2 , 4 , 7 , 15 , 16 ) Posterior tibial artery is one of the most crucial targets for nerve decompression in the TTS. MRI is helpful to rule out mass lesion, but it is also useful to show the compression to the nerve.…”

Magnetic Resonance Imaging Findings in Patients with Tarsal Tunnel Syndrome

“…Intraoperatively, the decompressed appeared flat at the site of contact with the arteriovenous complex. Others 2 , 7 , 24 , 31 , 32 ) also focused on vascular compression in idiopathic TTS; they reported good surgical results after the nerve was released from the posterior tibial artery. These findings indicate that the posterior tibial artery is an important target for nerve decompression in patients with TTS.…”