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CC BY-NC-ND 4.0 · Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery 2022; 41(02): e145-e152
DOI: 10.1055/s-0042-1742425
Review Article

Surgical Treatment Compared to Conservative Treatment in Remission of Pain and Hyposthesia in Tarsal Tunnel Syndrome – Systematic Review

Tratamento cirúrgico comparado ao tratamento conservador na remissão da dor e hipoestesia na síndrome do túnel do tarso – Revisão sistemática
Marcelo José da Silva de Magalhães 
1   Department of Neurosurgery, Hospital Vila da Serra, Nova Lima, MG, Brazil
2   Department of Neurosurgery, Hospital Aroldo Tourinho, Montes Claros, MG, Brazil
3   Department of Medicine, Universidade Funorte, Montes Claros, MG, Brazil
,
Iara Cristina Vieira Ribeiro 
3   Department of Medicine, Universidade Funorte, Montes Claros, MG, Brazil
,
Márcio de Mendonça Cardoso 
4   Department of Neurological Surgery, Sarah Network of Rehabilitation Hospitals, Brasília, DF, Brazil
,
Ricardo de Amoreira Gepp 
4   Department of Neurological Surgery, Sarah Network of Rehabilitation Hospitals, Brasília, DF, Brazil
› Institutsangaben 6.0 - Funding Acknowledgements This work was supported by PROCIÊNCIA.
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Abstract

Introduction Tarsal tunnel syndrome (TTS) is caused by compression of the posterior tibial nerve.

Objective To evaluate the effectiveness of surgical treatments compared to conservative treatments in reducing the symptoms of the syndrome.

Methods The PubMed, Lilacs, Cochrane Library, and PEDro databases were used for this review.

Results Only 11 articles were selected.

Conclusion The most common causes of TTS identified were presence of ganglia, bone prominence causing a talocalcaneal collision, trauma, varicose and idiopathic veins. The main symptom was pain in the medial plantar region and paresthesia that can radiate to the fingers or to the calf. Most patients have a positive Tinel sign upon physical examination. Electrodiagnostic test usually shows the presence of latency in sensory nerve conduction. There is no consensus suggesting that a longer time between diagnosis and surgical treatment leads to worse prognosis. In the group of operated patients, the ones who benefited most from the procedure were those who had a structure such as ganglion, cysts, or varicosities causing compression. The most cited surgical complications were postsurgical wound infection, wound dehiscence, and calcaneus hypoesthesia. Regarding surgical techniques, the release of the posterior tibial nerve via endoscopy had a favorable outcome in relation to the symptoms of pain and hypoesthesia, with no reports of infection of the operative site in the articles identified in this review. We observed a rate of good or excellent pain control of 68% (n = 204) for open surgery (n = 299), 100% (n = 8) for endoscopic surgery (n = 8), and 7% (n = 2) for conservative treatment (n = 28).

Resumo

Introdução A síndrome do túnel do tarso (STT) é causada pela compressão do nervo tibial posterior.

Objetivo Avaliar a eficácia dos tratamentos cirúrgicos em comparação aos conservadores na redução dos sintomas da síndrome.

Métodos Foram utilizados as bases de dados PubMed, Lilacs, Cochrane Library e PEDro.

Resultados Apenas 11 artigos foram selecionados.

Conclusão As causas mais comuns de STT identificadas foram presença de gânglios, proeminência óssea causando colisão talocalcânea, trauma, varizes e veias. O principal sintoma foi dor na região plantar medial e parestesia, que pode irradiar para os dedos ou panturrilha. A grande maioria dos pacientes apresenta um sinal de Tinel positivo no exame físico. O teste eletrodiagnóstico geralmente mostra a presença de latência na condução nervosa sensorial. Não há consenso de que o maior tempo entre o diagnóstico e o tratamento cirúrgico leva a um pior prognóstico. No grupo de pacientes operados, os que mais se beneficiaram com o procedimento foram aqueles que apresentavam estrutura como gânglio, cistos ou varicosidades causando compressão. As complicações cirúrgicas mais citadas foram infecção da ferida operatória, deiscência da ferida e hipoestesia do calcâneo. A cirurgia endoscópica teve evolução favorável em relação aos sintomas de dor e hipoestesia, não havendo relato de infecção do sítio operatório. Observou-se que a taxa de bom ou excelente controle da dor foi de 68% (n = 204) para cirurgia aberta (n = 299), 100% (n = 8) para cirurgia endoscópica (n = 8), e 7% (n = 2) para o tratamento conservador (n = 28).

Keywords

tarsal tunnel syndrome - posterior tibial nerve - conservative treatment - surgical treatment.

Palavras-chave

síndrome do túnel do tarso - nervo tibial posterior - tratamento conservador - tratamento cirúrgico.


Publikationsverlauf

Eingereicht: 15. Juli 2021

Angenommen: 13. Oktober 2021

Artikel online veröffentlicht:
03. März 2022

© 2022. Sociedade Brasileira de Neurocirurgia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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