Neurovascular bundle decompression without excessive dissection for tarsal tunnel syndrome

Area of Science:

• Orthopedics
• Neurology
• Surgical Innovation

Background:

• Tarsal tunnel syndrome (TTS) is a neuropathy caused by posterior tibial nerve compression.
• Effective surgical treatment is crucial for managing TTS symptoms.

Purpose of the Study:

• To evaluate the clinical outcomes of a less invasive surgical approach for tarsal tunnel syndrome.
• To assess the efficacy and safety of a minimally invasive decompression technique.

Main Methods:

• A cohort of 69 patients (116 feet) underwent surgical decompression of the tarsal tunnel under local anesthesia.
• Microscopic sharp dissection of the flexor retinaculum and surrounding connective tissues was performed.
• Intraoperative symptom assessment and confirmation of sufficient arterial pulsation guided decompression completion.

Main Results:

• Significant symptom reduction was observed, with 92% experiencing decreased numbness/pain and 95% reduced foreign body sensation.
• Overall patient satisfaction was high, with 68% reporting satisfactory outcomes and 22% acceptable outcomes.
• A low re-operation rate of 3% (4 feet) was noted, with reasons including insufficient initial decompression or distal tunnel involvement.

Conclusions:

• The presented less invasive surgical technique for tarsal tunnel syndrome is effective and safe.
• Local anesthesia allows for intraoperative confirmation of symptom relief, minimizing excessive dissection and preventing adhesions.
• This method offers a simple, safe approach to neurovascular bundle decompression for tarsal tunnel syndrome.