Results of ultrasound-guided release of tarsal tunnel syndrome: a review of 81 cases with a minimum follow-up of 18 mont
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(2020) 15:30
RESEARCH ARTICLE
Open Access
Results of ultrasound-guided release of tarsal tunnel syndrome: a review of 81 cases with a minimum follow-up of 18 months A. Iborra1,2*, M. Villanueva3 and P. Sanz-Ruiz3
Abstract Background: This study aims to analyse the clinical results of ultrasound-guided surgery for the decompression of the tibial nerve, including its distal medial and lateral branches, to treat tarsal tunnel syndrome. These structures are the complete flexor retinaculum and the deep fascia of the abductor hallucis muscle, including individualised release of the medial and lateral plantar nerve tunnels. Method: This is a retrospective review of 81 patients (36 men and 45 women) with an average age of 41 years old (32–62) and an average clinical course of 31 months (8–96) compatible with idiopathic tarsal tunnel syndrome, who underwent ultrasound-guided decompression of the proximal and distal tarsal tunnel between February 2015 and November 2017 (both months included), with a minimum follow-up of 18 months. Results: Based on the Takakura et al. scale for the 81 patients, 76.54% obtained excellent results, 13.58% good results, and 9.87% poor results. The patients with the longest course of symptoms displayed the worst results. Conclusion: Although 9% of patients did not improve, ultrasound-guided tarsal tunnel release might be a viable alternative to conventional open approaches. Keywords: Tarsal tunnel syndrome, Heel pain syndrome, Ultrasound-guided surgery, Tibial nerve, Medial plantar nerve, Lateral plantar nerve
Introduction Fifteen percent of adults experience pain in the plantar region and heel at some point in their lifetimes. One of the causes of this pain is tarsal tunnel syndrome. The prevalence of tarsal tunnel syndrome (TTS) described in the literature is lower than that of other compressive neuropathies. However, some authors consider that it is underdiagnosed or occasionally misdiagnosed as plantar fasciitis [1]. TTS is a peripheral neuropathy caused by entrapment of the tibial nerve and its branches in the flexor * Correspondence: [email protected] 1 Department of Podiatry, Faculty of Health Sciences, University of La Salle, Institute Avanfi, 28020 Madrid, Spain 2 Avanfi Institute and Unit for Ultrasound-guided Surgery, Hospital Beata María Ana, Calle Orense 32, 1, 28020 Madrid, Spain Full list of author information is available at the end of the article
retinaculum of the ankle located in the deep fascia of the abductor in the rearfoot [2, 3]. The first anatomical description of the tarsal tunnel is attributed to Richter in 1897, and the first clinical description of TTS was provided by Von Malisé [4] in 1918. Subsequently, in 1987, Heimkes et al. [5] described a distal tarsal tunnel syndrome, defined as compression from the deep portion of the abductor hallucis muscle (AHM) and its fascia, the confluence of the deep abductor fascia, and the medial edge of the plantar fascia, over the fascia, and by the quadratus plantae muscle. Meanwhile, the descriptive anatomy of this r
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