Neurovascular Bundle Decompression without Excessive Dissection for Tarsal Tunnel Syndrome

Tarsal tunnel syndrome (TTS) is an entrapment neuropathy of the posterior tibial nerve and its branches in the tarsal tunnel. We present our less invasive surgical treatment of TTS in 69 patients (116 feet) and their clinical outcomes. The mean follow-up period was 64.6 months. With the patient unde...

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Veröffentlicht in:Neurologia medico-chirurgica 2014, Vol.54(11), pp.901-906
Hauptverfasser: KIM, Kyongsong, ISU, Toyohiko, MORIMOTO, Daijiro, SASAMORI, Toru, SUGAWARA, Atsushi, CHIBA, Yasuhiro, ISOBE, Masahiro, KOBAYASHI, Shiro, MORITA, Akio
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container_issue 11
container_start_page 901
container_title Neurologia medico-chirurgica
container_volume 54
creator KIM, Kyongsong
ISU, Toyohiko
MORIMOTO, Daijiro
SASAMORI, Toru
SUGAWARA, Atsushi
CHIBA, Yasuhiro
ISOBE, Masahiro
KOBAYASHI, Shiro
MORITA, Akio
description Tarsal tunnel syndrome (TTS) is an entrapment neuropathy of the posterior tibial nerve and its branches in the tarsal tunnel. We present our less invasive surgical treatment of TTS in 69 patients (116 feet) and their clinical outcomes. The mean follow-up period was 64.6 months. With the patient under local anesthesia we use a microscope to perform sharp dissection of the flexor retinaculum and remove the connective tissues surrounding the posterior tibial nerve and vessels. To prevent postoperative adhesion and delayed neuropathy, decompression is performed to achieve symptom improvement without excessive dissection. Decompression is considered complete when the patient reports intraoperative symptom abatement and arterial pulsation is sufficient. The sensation of numbness and/or pain and of foreign substance adhesion was reduced in 92% and 95% of our patients, respectively. In self-assessments, 47 patients (68%) reported the treatment outcome as satisfactory, 15 (22%) as acceptable, and 7 (10%) were dissatisfied. Of 116 feet, 4 (3%) required re-operation, initial decompression was insufficient in 2 feet and further decompression was performed; in the other 2 feet improvement was achieved by decompression of the distal tarsal tunnel. Our surgical method involves neurovascular bundle decompression to obtain sufficient arterial pulsation. As we use local anesthesia, we can confirm symptom improvement intraoperatively, thereby avoiding unnecessary excessive dissection. Our method is simple, safe, and without detailed nerve dissection and it prevents postoperative adhesion.
doi_str_mv 10.2176/nmc.oa.2014-0090
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Of 116 feet, 4 (3%) required re-operation, initial decompression was insufficient in 2 feet and further decompression was performed; in the other 2 feet improvement was achieved by decompression of the distal tarsal tunnel. Our surgical method involves neurovascular bundle decompression to obtain sufficient arterial pulsation. As we use local anesthesia, we can confirm symptom improvement intraoperatively, thereby avoiding unnecessary excessive dissection. 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Med. Chir.(Tokyo)</addtitle><description>Tarsal tunnel syndrome (TTS) is an entrapment neuropathy of the posterior tibial nerve and its branches in the tarsal tunnel. We present our less invasive surgical treatment of TTS in 69 patients (116 feet) and their clinical outcomes. The mean follow-up period was 64.6 months. With the patient under local anesthesia we use a microscope to perform sharp dissection of the flexor retinaculum and remove the connective tissues surrounding the posterior tibial nerve and vessels. To prevent postoperative adhesion and delayed neuropathy, decompression is performed to achieve symptom improvement without excessive dissection. Decompression is considered complete when the patient reports intraoperative symptom abatement and arterial pulsation is sufficient. The sensation of numbness and/or pain and of foreign substance adhesion was reduced in 92% and 95% of our patients, respectively. 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subjects Adult
Aged
Aged, 80 and over
Anesthesia, Local
decompression
Dissection - methods
entrapment neuropathy
Female
Follow-Up Studies
Humans
Male
Microvascular Decompression Surgery - methods
Middle Aged
Original
tarsal tunnel syndrome
Tarsal Tunnel Syndrome - diagnosis
Tarsal Tunnel Syndrome - surgery
title Neurovascular Bundle Decompression without Excessive Dissection for Tarsal Tunnel Syndrome
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