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Neurolysis for failed tarsal tunnel surgery
Merter Yalcinkaya1, Utku Erdem Ozer2, M Burak Yalcin2
1Orthopaedic Surgeon, Department of Orthopaedic Surgery and Traumatology, Metin Sabanci Baltalimani Bone Diseases Training and Research Hospital, Istanbul, Turkey.
Summary
Revision surgery for failed tarsal tunnel release revealed insufficient nerve decompression as the primary cause. Complete release of the four distinct tarsal tunnels and early mobilization led to satisfactory outcomes in revision cases.
Area of Science:
- Orthopedic Surgery
- Podiatric Surgery
- Nerve Surgery
Background:
- Tarsal tunnel syndrome (TTS) can lead to persistent or recurrent symptoms despite initial surgical release.
- Identifying the causes of failure in tarsal tunnel release is crucial for optimizing revision surgical strategies.
Observation:
- A retrospective review of 8 patients undergoing revision tarsal tunnel release for idiopathic TTS was conducted.
- Operative findings in revision surgery included insufficient release of the tarsal tunnel, particularly distally, in all patients.
- Fibrosis of the tibialis posterior nerve was noted in one patient (12.5%).
Findings:
- The primary cause of failed tarsal tunnel release was insufficient decompression of the tibial nerve and its branches within the tarsal tunnel.
- Revision surgery involved releasing the tibialis posterior, medial plantar, lateral plantar, and medial calcaneal nerves, along with septum resection.
- Subjective patient satisfaction outcomes were excellent in 62.5%, good in 25%, and fair in 12.5%.
Implications:
- Comprehensive release of all four distinct tarsal tunnels and immediate mobilization may improve outcomes in revision tarsal tunnel surgery.
- Addressing distal entrapment and potential nerve fibrosis is essential for successful revision procedures.
- This study highlights the importance of thorough surgical technique in primary tarsal tunnel release to prevent secondary interventions.
