Analysis of surgical cases of tarsal tunnel syndrome in our department: Case series and literature review

Masatoshi Yunoki

doi:10.4103/ajns.AJNS_257_19

Asian Journal of Neurosurgery, Table of Contents

CC BY-NC-ND 4.0 · Asian J Neurosurg 2020; 15(01): 59-64
DOI: 10.4103/ajns.AJNS_257_19

Original Article

Analysis of surgical cases of tarsal tunnel syndrome in our department: Case series and literature review

Authors

Masatoshi Yunoki

Department of Neurosurgery, Kagawa Rosai Hospital, Marugame, Kagaw

Abstract

Background: Tarsal tunnel syndrome (TTS) is an entrapment neuropathy in which the tibial nerve is compressed within the tarsal tunnel and causes sensory disturbance in the sole of the foot. In this manuscript, we summarized our early surgical cases of TTS. Materials and Methods: Six feet in five patients with TTS were treated surgically. The patients were aged 31–70 years (mean 53.1 years), and all of them complained of pain or dysesthesia of the sole of the foot sparing the heel. Magnetic resonance imaging (MRI) and nerve conduction test were performed preoperatively. In surgery, flexor retinaculum was dissected (tarsal tunnel opening [TTO]), the posterior tibial nerve was freed from the arteriovenous complex (neurovascular decompression [NVD]), and fascia of the abductor hallucis muscle was excised to decompress the medial and lateral plantar nerve (releasing fascial of abductor hallucis muscle [RFAH]). Results: Preoperative MRI confirmed that all seven cases were idiopathic TTS. Moreover, NCD demonstrated delayed sensory conduction velocity but not delayed distal motor latency. Surgical decompression was beneficial in 5 feet. The recurrence of symptoms was found in one case within 1 postoperative month. Conclusion: Surgical treatment for idiopathic TTS with TTO, NVD, and RFAH was generally good. However, symptoms recurred in one instance. Some methods to prevent adhesion and granulation in the reconstructed tarsal tunnel should be considered.

Key-words:

Nerve conduction study - surgery - tarsal tunnel syndrome

Full Text

References

References
1 Kushner S, Reid DC. Medial tarsal tunnel syndrome: A review. J Orthop Sports Phys Ther 1984;6:39-45.
2 McSweeney SC, Cichero M. Tarsal tunnel syndrome-a narrative literature review. Foot (Edinb) 2015;25:244-50.
3 Frey C, Kerr R. Magnetic resonance imaging and the evaluation of tarsal tunnel syndrome. Foot Ankle 1993;14:159-64.
4 Mondelli M, Morana P, Padua L. An electrophysiological severity scale in tarsal tunnel syndrome. Acta Neurol Scand 2004;109:284-9.
5 Galardi G, Amadio S, Maderna L, Meraviglia MV, Brunati L, Dal Conte G, et al. Electrophysiologic studies in tarsal tunnel syndrome. Diagnostic reliability of motor distal latency, mixed nerve and sensory nerve conduction studies. Am J Phys Med Rehabil 1994;73:193-8.
6 Baba H, Wada M, Annen S, Azuchi M, Imura S, Tomita K, et al. The tarsal tunnel syndrome: Evaluation of surgical results using multivariate analysis. Int Orthop 1997;21:67-71.
7 Takakura Y, Kitada C, Sugimoto K, Tanaka Y, Tamai S. Tarsal tunnel syndrome. Causes and results of operative treatment. J Bone Joint Surg Br 1991;73:125-8.
8 Torres AL, Ferreira MC. Study of the anatomy of the tibial nerve and its branches in the distal medial leg. Acta Ortop Bras 2012;20:157-64.
9 Yasunaga T, Kudo Y, Yamashita K, Kinone K, Tachibana S, Nishijima Y. An anatomical study of the calcaneal nerve in the tarsal tunnel. Spinal Surg 2009;23:164-7.
10 Keck C. The tarsal-tunnel syndrome. J Bone Joint Surg 1962;44A:180-2.
11 Lam SJ. A tarsal-tunnel syndrome. Lancet 1962;2:1354-5.
12 Hudes K. Conservative management of a case of tarsal tunnel syndrome. J Can Chiropr Assoc 2010;54:100-6.
13 Kaplan PE, Kernahan WT Jr. Tarsal tunnel syndrome: An electrodiagnostic and surgical correlation. J Bone Joint Surg Am 1981;63:96-9.
14 Oh SJ, Arnold TW, Park KH, Kim DE. Electrophysiological improvement following decompression surgery in tarsal tunnel syndrome. Muscle Nerve 1991;14:407-10.
15 Turan I, Rivero-Melián C, Guntner P, Rolf C. Tarsal tunnel syndrome. Outcome of surgery in longstanding cases. Clin Orthop Relat Res 1997;343:151-6.
16 Zheng C, Zhu Y, Jiang J, Ma X, Lu F, Jin X, et al. The prevalence of tarsal tunnel syndrome in patients with lumbosacral radiculopathy. Eur Spine J 2016;25:895-905.
17 Ormeci T, Mahirogulları M, Aysal F. Tarsal tunnel syndrome masked by painful diabetic polyneuropathy. Int J Surg Case Rep 2015;15:103-6.
18 Lee CH, Dellon AL. Prognostic ability of tinel sign in determining outcome for decompression surgery in diabetic and nondiabetic neuropathy. Ann Plast Surg 2004;53:523-7.
19 Kim K, Isu T, Morimoto D, Sasamori T, Sugawara A, Chiba Y, et al. Neurovascular bundle decompression without excessive dissection for tarsal tunnel syndrome. Neurol Med Chir (Tokyo) 2014;54:901-6.
20 Raikin SM, Minnich JM. Failed tarsal tunnel syndrome surgery. Foot Ankle Clin 2003;8:159-74.
21 DiStefano V, Sack JT, Whittaker R, Nixon JE. Tarsal-tunnel syndrome. Review of the literature and two case reports. Clin Orthop Relat Res 1972;88:76-9.
22 Kohno M, Takahashi H, Segawa H, Sano K. Neurovascular decompression for idiopathic tarsal tunnel syndrome: Technical note. J Neurol Neurosurg Psychiatry 2000;69:87-90.
23 Hong JT, Lee SW, Son BC, Sano K. Surgical experiences of the tarsal tunnel syndrome. J Korean Neurosurg Soc 2004;36:443-7.
24 Heimkes B, Posel P, Stotz S, Wolf K. The proximal and distal tarsal tunnel syndromes. An anatomical study. Int Orthop 1987;11:193-6.
25 Nagayasu T, Tachibana S, Kudo Y, Chotoku S. Vascular wrapping using the flexor retinaculum as a new method for tarsal tunnel syndrome. Spinal Surg 2011;25:209-11.