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Search Results for : Tarsal Tunnel Syndrome
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Segmental analysis of motor conduction velocity in distal tracts of tibial nerve: a coaxial needle electrode study.
Author(s): Troni, W; Parino, E; Pisani, PC; Pisani, G
Journal: Clin Neurophysiol 2010 Mar 10; Vol. 121, Issue 2; Page(s) 221-7
[Medline ID - 19948425]

OBJECTIVE: To describe a new method of segmental analysis of motor nerve conduction velocity (mCV) in the tibial nerve (Tn) tract distal to the upper margin of the tarsal tunnel (TT). METHODS: Compound muscle action potentials (CMAPs) were recorded with a coaxial needle electrode from the flexor hallucis brevis muscle (FHB), to test the medial plantar nerve (MPn), and from the flexor digiti quinti brevis (FDQB) and the first dorsal interosseous (FDI) muscles, to test the superficial and deep branches of the lateral plantar nerve (sLPn and dLPn, respectively). CMAPs were elicited by stimulating at three sites located above (S1) and below (S2) the TT and at the sole of the foot (S3 for MPn and S4 for LPn). RESULTS: In 20 normal subjects the mean mCV in the proximal (S1 to S2) tract was 44.5+/-4.7, 43.5+/-5.9 and 42.6+/-4.2m/s for the MPn, sLPn and dLPn, respectively. The corresponding values in the intermediate tract (S1 to S3/S4) were 40.7+/-5.6, 39.4+/-5.6 and 40.9+/-5.8m/s. CONCLUSIONS: Segmental analysis of mCV in distal Tn can be performed when CMAPs are recorded using a coaxial needle electrode, which prevents simultaneous recording of activity from nearby muscles groups. SIGNIFICANCE: Conventional neurophysiological examination for suspected entrapments in distal Tn usually can not discriminate between a lesion inside the TT or distal to it. The proposed technique, as suggested by the reported results in clinical application, may help to better define the lesion site.

Tibial nerve decompression in patients with tarsal tunnel syndrome: pressures in the tarsal, medial plantar, and lateral plantar tunnels.
Author(s): Rosson, GD; Larson, AR; Williams, EH; Dellon, AL
Journal: Plast Reconstr Surg 2009 Dec 25; Vol. 124, Issue 4; Page(s) 1202-10
[Medline ID - 19935304]

BACKGROUND: The anatomical basis for the surgical techniques used to treat tarsal tunnel syndrome is not well studied. The authors sought to evaluate their hypotheses that (1) pronation and pronation with plantar flexion of the intact foot would have higher pressures than the intact foot in other positions; (2) decompression surgery would significantly lower the pressure in all three tunnels in all foot positions, and roof incision plus septum excision would lower the pressure further in some positions; and (3) the pressures in symptomatic patients would be significantly higher than those in an analogous cadaver study. METHODS: In 10 patients with tarsal tunnel syndrome, the authors intraoperatively measured pressures in the tarsal, medial plantar, and lateral plantar tunnels in multiple foot positions before and after excision of the tunnel roofs and intertunnel septum. RESULTS: The authors found that (1) pronation and plantar flexion significantly increased pressures in the medial and lateral plantar tunnels, to levels sufficient to cause chronic nerve compression; (2) tunnel release and septum excision significantly decreased those pressures; and (3) compared with cadaver pressures, patients had similar tarsal tunnel pressures but higher lateral plantar tunnel pressures in some positions. CONCLUSIONS: Many surgeons operating on patients with tarsal tunnel syndrome do not decompress the respective medial plantar and lateral plantar nerves and excise the septum. The authors' study validates the hypotheses that patients who are clinically suspected of having chronic compression of the tibial nerve and its branches at the ankle have higher tunnel pressures and that releasing these structures decreases the pressures.

Malunited calcaneal fracture fragments causing tarsal tunnel syndrome: a rare cause.
Author(s): Manasseh, N; Cherian, VM; Abel, L
Journal: Foot Ankle Surg 2010 Jan 20; Vol. 15, Issue 4; Page(s) 207-9
[Medline ID - 19840754]

This is a report of tarsal tunnel syndrome (TTS) due to a specific malunited calcaneal fracture fragment in a 46-year-old man. He was treated non-operatively for extra-articular calcaneal fracture. Four months later he presented with pain, tingling and hypoaesthesia over the medial aspect of the heel. He had a positive Tinel's sign and a positive dorsiflexion-eversion test. Radiography revealed malunited calcaneal fracture along medial wall producing bony prominence. The tarsal tunnel was surgically decompressed by excising the malunited fragments. The branches of the posterior tibial nerve were stretched over these fragments intra-operatively. There was symptomatic improvement with surgical excision of the fragment, however, the hypoesthesia did not resolve completely. Appropriate initial treatment will help to prevent this complication.

Tarsal tunnel surgery secondary to a tarsal ganglion: be prepared before performing this complicated operation.
Author(s): Cione, JA; Cozzarelli, J; Mullin, CJ; Dellon, AL
Journal: Foot Ankle Spec 2010 Jan 27; Vol. 2, Issue 1; Page(s) 35-40
[Medline ID - 19825749]

Tarsal tunnel surgery complicated with ganglia or any other type of cystic mass can be a very challenging operation. Preoperative planning before any tarsal tunnel surgery involving a soft-tissue mass is imperative. Plans to reconstruct the posterior tibial nerve and/or artery should be in place. The authors will present a case study that involved tarsal tunnel syndrome with an associated ganglion in the tarsal canal. They will review what microsurgical techniques and equipment should be on hand prior to performing this complicated surgical procedure.

[Assessing the treatment for sacroiliac joint dysfunction, piriformis syndrome and tarsal tunnel syndrome associated with lumbar degenerative disease]
Author(s): Morimoto, D; Isu, T; Shimoda, Y; Hamauchi, S; Sasamori, T; Sugawara, A; Kim, K; Matsumoto, R; Isobe, M
Journal: No Shinkei Geka 2009 Dec 16; Vol. 37, Issue 9; Page(s) 873-9
[Medline ID - 19764421]

OBJECTIVE: Sacroiliac joint (SIJ) dysfunction, piriformis syndrome (PFS) and tarsal tunnel syndrome (TTS) produce symptoms similar to lumbar degenerative disease (LDD). Patients who have these diseases plus LDD sometimes experience residual symptoms after surgery for LDD. We therefore assessed the results of treatment of SIJ dysfunction, PFS and TTS associated with LDD. PATIENTS AND METHODS: We assessed 25 patients who underwent surgery for LDD and were affected with SIJ dysfunction (12 patients), PFS (7 patients) or TTS (6 patients). SIJ dysfunction was treated with rest, drugs, pelvic band and sacroiliac joint block. PFS was treated with rest, drugs, physical exercise, injection of local anesthetic into the piriformis muscle, and surgical resection of the piriformis muscle. TTS was treated with drugs and tarsal tunnel opening. We analyzed the improvement score and recovery rate (JOA score) for both LDD surgery and the treatment of SIJ dysfunction, PFS and TTS. RESULT S: Symptom improvement was observed in all patients with SIJ dysfunction and PFS and in 4 patients with TTS. The improvement score and recovery rate of treatments for SIJ dysfunction, PFS and TTS were lower than those of surgery for LDD. CONCLUSION: The improvement score and recovery rate of treatment for SIJ dysfunction, PFS and TTS were not as high as those for LDD. To enhance patient satisfaction, it is important to consider these complicating diseases when designing treatments for LDD.

Short-term operative outcome of tarsal tunnel syndrome due to benign space-occupying lesions.
Author(s): Sung, KS; Park, SJ
Journal: Foot Ankle Int 2009 Oct 30; Vol. 30, Issue 8; Page(s) 741-5
[Medline ID - 19735629]

BACKGROUND: It has been reported that the operative outcome of tarsal tunnel syndrome caused by space-occupying lesions is more favorable than those caused by other reasons. The purpose of this clinical study was to report our clinical results after surgical treatment for tarsal tunnel syndrome caused by benign space-occupying lesions. MATERIALS AND METHODS: From July 2004 to February 2007, 20 patients underwent surgical decompression for tarsal tunnel syndrome in our institution. Out of them, 13 cases were due to space-occupying lesions around the tarsal tunnel. The average age was 51.3 and the mean symptom duration was 16.5 months. The operation included complete release of the tarsal tunnel and removal of the space-occupying lesion. The clinical outcomes measured were a pain visual analogue scale (VAS), AOFAS score and the degree of subjective satisfaction. RESULTS: Ganglion was the most frequent cause (10 cases). Other pathologies included synovial chondromatosis, a Schwannoma and a talocalcaneal coalition. There was a significant improvement after surgery in term of VAS (6.4/2.2) and AOFAS score (77.8/92.7). Seven of 13 were satisfied with the results, three felt they had a fair result, and three were dissatisfied. CONCLUSION: Though significant improvement was found in the average VAS and AOFAS score, subjective satisfaction was less favorable (54%) than expected. We believe surgeons should be more cautious concerning outcomes when expectations of surgery are discussed with patients.

Claw toes after tibial fracture in children.
Author(s): Fitoussi, F; Ilharreborde, B; Guerin, F; Souchet, P; Penne; çot, GF; Mazda, K
Journal: J Child Orthop 2010 Oct 1; Vol. 3, Issue 5; Page(s) 339-43
[Medline ID - 19701658]

PURPOSE: The development of claw toe deformity following fracture of the tibia in children has not been described in our review of the literature. We report on the management of the acquired claw toe deformity after tibia fracture in five children. METHODS: We report on five patients, between 5 and 15 years of age, who developed clawing of the hallux following a fracture of the tibia. In two patients, the lesser toes were involved. On examination, when the ankle was passively plantar flexed, a flexion contracture of the interphalangeal joint of the hallux became fully flexible. When the ankle was dorsiflexed, the clawing became more obvious and fixed. A magnetic resonance imaging (MRI) study in two cases demonstrated fibrosis under or just proximal to the tarsal tunnel. RESULTS: The contractures were relieved by performing a tenolysis proximal to the medial malleolus. The operative findings demonstrated that the etiology could be possibly associated with a localized subclinical compartment syndrome. CONCLUSIONS: We described five patients with a claw toe deformity following a tibia fracture associated with adhesions of the flexor hallucis longus (FHL) and flexor digitorum longus (FDL) muscles to the surrounding structures under or just proximal to the flexor retinaculum. It is the authors' opinion that this condition may be related to a subclinical compartment syndrome localized in the distal part of the deep posterior compartment. Soft-tissue release without tendon lengthening allowed recovery in all patients.

Tarsal tunnel syndrome: assessment of treatment outcome with an anatomic pain intensity scale.
Author(s): Gondring, WH; Trepman, E; Shields, B
Journal: Foot Ankle Surg 2009 Sep 30; Vol. 15, Issue 3; Page(s) 133-8
[Medline ID - 19635420]

BACKGROUND: Assessment of treatment outcomes for tarsal tunnel syndrome may be improved with a standardized pain rating scale using a descriptive anatomical foot model for pretreatment and post-treatment plantar foot pain analysis. METHODS: Prospective evaluation of 46 consecutive patients (56 feet) who had non-operative and surgical treatment for tarsal tunnel syndrome. Pain intensity was documented before and after treatment with the Wong-Baker FACES Pain Rating Scale applied to the anatomic nerve regions of the plantar aspect of the foot. RESULTS: In patients who had successful non-operative treatment, overall pain intensity was significantly improved in the medial calcaneal, medial plantar, and lateral plantar nerve regions. In patients who had ongoing symptoms despite non-operative treatm ent, surgical treatment resulted in significant pain improvement in the medial calcaneal and medial plantar, but not lateral plantar, nerve regions. Pretreatment motor nerve conduction latency was significantly greater in patients who had surgical treatment than those who had only non-operative treatment. CONCLUSIONS: Anatomic pain intensity rating models may be useful in the pretreatment and follow-up evaluation of tarsal tunnel syndrome. Predictors of failed non-operative treatment included longer motor nerve conduction latency and greater predominance of foot comorbidities.

Posterior tarsal tunnel syndrome: diagnosis and treatment.
Author(s): Antoniadis, G; Scheglmann, K
Journal: Dtsch Arztebl Int 2009 Jul 7; Vol. 105, Issue 45; Page(s) 776-81
[Medline ID - 8056802]

BACKGROUND: Posterior tarsal tunnel syndrome is an uncommon clinical entity which is sometimes misdiagnosed in patients with pain of the retromalleolar region and the plantar aspect of the foot. Surgical intervention is recommended for correctly diagnosed posterior tarsal tunnel syndrome. METHODS: Selective literature review. RESULTS: Surgical treatment is indicated in the presence of dysesthesias refractory to conservative treatment or of neurological deficits. If a neural tumor or tarsal tunnel ganglion is suspected, diagnostic imaging (MRI, neurosonography) should precede surgery. Division of the flexor retinaculum (ligamentum laciniatum) in the tarsal tunnel must always include distal decompression of the end branches of the tibial nerve posterior to the fascia of the abductor hallucis muscle. Only extensive exposure of the nerve guarantees adequate release. CONCLUSION: Accurate diagnosis requires the evaluation of relevant clinical, neurological, and neurophysiological findings along with the careful consideration of other possible diagnoses. High success rates of 44% to 91% are reported after operative treatment. The results are better in idiopathic than in posttraumatic cases. If surgery fails, re-operation is indicated only in patients with inadequate release.

Peripheral nerve sheath tumor of the medial plantar nerve without tarsal tunnel syndrome: a case report.
Author(s): Kwon, JH; Yoon, JR; Kim, TS; Kim, HJ
Journal: J Foot Ankle Surg 2009 Oct 3; Vol. 48, Issue 4; Page(s) 477-82
[Medline ID - 19577727]

Peripheral nerve sheath tumors are relatively uncommon soft tissue tumors, and the incidence of peripheral nerve sheath tumors localized to the plantar surface of the foot, without symptoms of tarsal tunnel syndrome, is even more rare. In this report, we present the rare case of a patient with a peripheral nerve sheath tumor originating from the medial plantar nerve in the plantar vault. The tumor was enucleated and fully excised under microscopic inspection using fine-tipped instrumentation, without en bloc resection of the associated nerve trunk. Surgeons should consider peripheral nerve sheath tumor as a cause of plantar foot pain, despite the rarity of this disorder. Level of Clinical Evidence: 4.
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