PDF herunterladen
J Reconstr Microsurg 2008; 24(2): 119-126
DOI: 10.1055/s-2008-1076089
© Thieme Medical Publishers

Results of Decompression of Four Medial Ankle Tunnels in the Treatment of Tarsal Tunnels Syndrome

Tarun Mullick1 , A. Lee Dellon1
  • 1Division of Plastic Surgery, Department of Surgery, Department of Neurological Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
Weitere Informationen

Publikationsverlauf

Publikationsdatum:
05. Mai 2008 (online)

Auch verfügbar auf
    Lizenzen und Reprints

ABSTRACT

Controversy surrounds the surgical approach and efficacy for tibial nerve compression at the ankle. The hypotheses tested are that the poor published results are due to failure to recognize that the tarsal tunnel is analogous to the forearm, not the carpal tunnel, and that postoperative ankle immobilization contributes to poor results by permitting fibrosis of the tibial nerve branches. From January of 1987 through December of 1994, a consecutive series of 77 patients with tarsal tunnel syndrome was accrued, 10 of whom had the condition bilaterally. The surgical approach included a neurolysis of the tibial nerve in the tarsal tunnel and the medial, lateral plantar, calcaneal nerves in their own tunnels. Postoperatively, immediate weight bearing and ambulation were permitted in a bulky cotton dressing. The dressing was removed at 1 week. For the 87 legs, mean follow-up after surgery was 3.6 years. Utilizing the traditional postoperative assessment, there were 82% excellent, 11% good, 5% fair, and 2% poor results. Utilizing a numerical grading scale, there was a statistically significant improvement at the p < 0.001 level for sensory and also for motor impairment. Recognition that decompression of four medial ankle tunnels and immediate postoperative mobilization of the tibial nerve through ambulation is necessary results in a high level of success for patients with tarsal tunnels syndrome.

KEYWORDS

Tarsal tunnel - plantar nerves - neurolysis

REFERENCES

  • 1 Keck C. The tarsal-tunnel syndrome.  J Bone Joint Surg Am. 1962;  44A 180-182
    PubMedGoogle Scholar
  • 2 Lam S JS. A tarsal-tunnel syndrome.  Lancet. 1962;  2 1354-1355
    PubMedGoogle Scholar
  • 3 Goodgold J, Kopell H P, Spielholz N I. The tarsal tunnel syndrome: objective diagnostic criteria.  N Engl J Med. 1965;  273 742-745
    PubMedGoogle Scholar
  • 4 Cimino W R. Tarsal tunnel syndrome: review of the literature.  Foot Ankle. 1990;  11 47-52
    CrossrefPubMedGoogle Scholar
  • 5 Grumbine N A, Radovic P A, Parsons R, Scheinin G S. Tarsal tunnel syndrome. comprehensive review of 87 cases.  J Am Podiatr Med Assoc. 1990;  80 457-461
    PubMedGoogle Scholar
  • 6 Carrel J M, Davidson D M, Goldstein K T. Observations on 200 surgical cases of tarsal tunnel syndrome.  Clin Podiatr Med Surg. 1994;  11 609-616
    PubMedGoogle Scholar
  • 7 Kalla T P. Tarsal tunnel syndrome.  Adv Pod Med Surg. 1996;  2 1-16
    PubMedGoogle Scholar
  • 8 Lau J TC, Daniels T R. Tarsal tunnel syndrome: a review of the literature.  Foot Ankle Int. 1999;  20 201-209
    PubMedGoogle Scholar
  • 9 Haddad S L. Compressive neuropathies of the foot and ankle. Chapter 33. In: Myerson MS Foot and Ankle Disorders. Philadelphia; WB Saunders 2000: 811-813
    Google Scholar
  • 10 Richardson E G. Neurogenic disorders. Chapter 83. In: Canale ST Campbell's Operative Orthopedics, 10th ed. St. Louise; Mosby 2003: 4129-4131
    Google Scholar
  • 11 Lam S J. Tarsal-tunnel syndrome.  J Bone Joint Surg Am. 1967;  49 87-92
    PubMedGoogle Scholar
  • 12 Edwards W G, Lincoln R, Bassett F H, Goldner J L. Tarsal tunnel syndrome.  JAMA. 1969;  207 716-720
    CrossrefPubMedGoogle Scholar
  • 13 Linscheid R L, Burton R C, Fredericks E J. Tarsal tunnel syndrome.  South Med J. 1970;  63 1313-1323
    PubMedGoogle Scholar
  • 14 Mann R A. Tarsal tunnel syndrome.  Orthop Clin North Am. 1974;  5 109-115
    PubMedGoogle Scholar
  • 15 Stern D S, Joyce M T. Tarsal tunnel syndrome: a review of 15 surgical procedures.  J Foot Surg. 1989;  28 290-294
    PubMedGoogle Scholar
  • 16 Byank R P, Curtis M J. Diagnosing tarsal tunnel syndrome.  Complications in Orthoped. 1992;  16 202-206
    PubMedGoogle Scholar
  • 17 Sammarco G J, Chalk D E, Feibel J H. Tarsal tunnel syndrome and additional nerve lesions in the same limb.  Foot Ankle. 1993;  14 71-77
    PubMedGoogle Scholar
  • 18 Pfeiffer W H, Cracchiolo A. Clinical results after tarsal tunnel decompression.  J Bone Joint Surg. 1994;  76 1222-1230
    PubMedGoogle Scholar
  • 19 Mahan K T, Rock J J, Hillstrom H J. Tarsal tunnel syndrome. A retrospective study.  J Am Podiatr Med Assoc. 1996;  86 81-91
    PubMedGoogle Scholar
  • 20 Turan I, Rivero-Melian C, Guntner P, Rolf C. Tarsal tunnel syndrome; outcome of surgery in longstanding cases.  Clin Orthop Relat Res. 1997;  343 151-156
    PubMedGoogle Scholar
  • 21 Baba H, Wada M, Annen S, Azuchi M, Imura S, Tomita K. The tarsal tunnel syndrome: evaluation of surgical results using multivariate analysis.  Int Orthop. 1997;  21 67-71
    CrossrefPubMedGoogle Scholar
  • 22 Bailie D S, Kelitian A S. The tarsal tunnel syndrome: surgical technique and functional outcome.  Foot Ankle Int. 1998;  19 65-71
    PubMedGoogle Scholar
  • 23 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
    CrossrefPubMedGoogle Scholar
  • 24 Gondring W H, Shields B, Wenger S. An outcomes analysis of surgical treatment of tarsal tunnel syndrome.  Foot Ankle Int. 2003;  24 545-549
    PubMedGoogle Scholar
  • 25 Mackinnon S E, Dellon A L. Homologies between the tarsal and carpal tunnels: Implications for surgical treatment in the tarsal tunnel syndrome.  Contemp Orthop. 1987;  14 75-78
    PubMedGoogle Scholar
  • 26 Mackinnon S E, Dellon A L. Surgery of the Peripheral Nerve. Chapter 12. New York; Thieme 1988
    Google Scholar
  • 27 Dellon A L. Computer assisted sensibility evaluation and the surgical treatment of tarsal tunnel syndrome.  Adv Pod Med Surg. 1996;  2 17-40
    PubMedGoogle Scholar
  • 28 Dellon A L, Mackinnon S E. Tibial nerve branching in the tarsal tunnel.  Arch Neurol. 1984;  41 645-646
    CrossrefPubMedGoogle Scholar
  • 29 Havel P E, Ebraheim N A, Clark S E, Jackson W T, Didio L. Tibial nerve branching in the tarsal tunnel.  Foot Ankle. 1988;  9 117-119
    PubMedGoogle Scholar
  • 30 Dellon A L, Kim J, Spaulding C M. Variations in the origin of the medial calcaneal nerve.  J Am Podiatr Med Assoc. 2002;  92 97-101
    PubMedGoogle Scholar
  • 31 Dellon A L. Wound healing in nerve.  Clin Plast Surg. 1990;  17 545-570
    PubMedGoogle Scholar
  • 32 Dellon A L, Mackinnon S E, Hudson A R, Hunter D A. Effect of submuscular versus intramuscular placement of ulnar nerve: experimental model in the primate.  J Hand Surg [Br]. 1986;  11 117-119
    PubMedGoogle Scholar
  • 33 Dellon A L. Treatment of symptoms of diabetic neuropathy by peripheral nerve decompression.  Plast Reconstr Surg. 1992;  89 689-697
    PubMedGoogle Scholar
  • 34 Trepman E, Kadel N J, Chisholm C ST, Razzano L. Effect of foot and ankle position on tarsal tunnel compartment pressure.  Foot Ankle Int. 1999;  20 721-726
    PubMedGoogle Scholar
  • 35 Dellon A L. Deciding when heel pain is of neural origin.  J Foot Ankle Surg. 2001;  40 341-345
    PubMedGoogle Scholar
  • 36 Dellon A L. Tinel or not Tinel?.  J Hand Surg [Br]. 1984;  9 216
    PubMedGoogle Scholar
  • 37 Johnson E W, Ortez P R. Electrodiagnosis of tarsal tunnel syndrome.  Arch Phys Med Rehabil. 1966;  47 776-780
    PubMedGoogle Scholar
  • 38 Marinacci A A. Neurological syndromes of the tarsal tunnels.  Bull Los Angeles Neurol Soc. 1968;  33 90-100
    PubMedGoogle Scholar
  • 39 Fu R, DeLiso J A, Kraft G H. Motor nerve latencies through the tarsal tunnel in normal adult subjects.  Arch Phys Med Rehabil. 1980;  61 243-248
    PubMedGoogle Scholar
  • 40 Kaplan P E, Kernahan W T. Tarsal tunnel syndrome: an electrodiagnostic and surgical correlation.  J Bone Joint Surg Am. 1981;  63 96-99
    PubMedGoogle Scholar
  • 41 Gatens P F, Saeed M A. Electromyographic findings in the intrinsic muscles of normal feet.  Arch Phys Med Rehab. 1982;  63 317-318
    PubMedGoogle Scholar
  • 42 Byank R P, Clarke H J, Bleeker M L. Standardized neurometric evaluation in tarsal tunnel syndrome.  Adv Orthop Surg. 1989;  16 249-253
    PubMedGoogle Scholar
  • 43 Mondelli M, Morana P, Padua L. An electrophysiological severity scale in tarsal tunnel syndrome.  Acta Neurol Scand. 2004;  109 284-289
    CrossrefPubMedGoogle Scholar
  • 44 Melvin J L, Johnson E W, Duran R. Electrodiagnosis after surgery for the carpal tunnel syndrome.  Arch Phys Med Rehabil. 1968;  49 502-507
    PubMedGoogle Scholar
  • 45 Le Quesne P M. Recovery of conduction velocity distal to a compressive lesion.  J Neurol Neurosurg Psychiatry. 1974;  37 1346-1351
    PubMedGoogle Scholar
  • 46 Wieman T J, Patel V G. Treatment of hyperesthetic neuropathic pain in diabetics; decompression of the tarsal tunnel.  Ann Surg. 1995;  221 660-665
    CrossrefPubMedGoogle Scholar
  • 47 Wood W A, Wood M A. Decompression of peripheral nerve for diabetic neuropathy in the lower extremity.  J Foot Ankle Surg. 2003;  42 268-275
    CrossrefPubMedGoogle Scholar
  • 48 Biddinger K R, Amend K J. The role of surgical decompression for diabetic neuropathy.  Foot Ankle Clin. 2004;  9 239-254
    CrossrefPubMedGoogle Scholar
  • 49 Valdivia J MV, Weinand M, Maloney C T. Surgical treatment of peripheral neuropathy: outcomes from 100 consecutive surgical cases.  J Am Pod Med Assoc. 2005;  95 451-454
    CrossrefPubMedGoogle Scholar
  • 50 Caffee H H. Decompression of peripheral nerves for diabetic neuropathy.  Plast Reconstr Surg. 2000;  106 813-815
    PubMedGoogle Scholar
  • 51 Aszmann O, Tassler P L, Dellon A L. Changing the natural history of diabetic neuropathy: incidence of ulcer/amputation in the contralateral limb of patients with a unilateral nerve decompression procedure.  Ann Plast Surg. 2004;  53 517-522
    CrossrefPubMedGoogle Scholar
  • 52 Dellon A L. Patient evaluation and management considerations in nerve compression.  Hand Clin. 1992;  8 229-240
    PubMedGoogle Scholar
  • 53 Dellon A L. A numerical grading scale for peripheral nerve function.  J Hand Ther. 1993;  6 152-160
    PubMedGoogle Scholar
  • 54 Dellon A L. Current guidelines for management of peripheral nerve problems.  J Orthop Surg (Hong Kong). 1999;  7 81-95
    PubMedGoogle Scholar
  • 55 Dellon A L. Clinical grading of peripheral nerve problems.  Neurosurg Clin N Am. 2001;  12 229-240
    PubMedGoogle Scholar
  • 56 Chang B, Dellon A L. Surgical management of recurrent carpal tunnel syndrome.  J Hand Surg Br. 1993;  18B 467-470
    PubMedGoogle Scholar
  • 57 Dellon A L, Hament W, Gittelsohn A. Non-operative management of cubital tunnel syndrome; results of eight year prospective study.  Neurol. 1993;  43 1673-1677
    PubMedGoogle Scholar
  • 58 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;  73 125-128
    PubMedGoogle Scholar

A. Lee DellonM.D. Ph.D. 

Suite 370, 3333 North Calvert Street

Baltimore, MD 21218