Functional Outcomes after Surgical Decompression for Tarsal Tunnel Syndrome

To evaluate the functional outcomes of surgical decompression for tarsal tunnel syndrome (TTS) and to explore the clinical relevance of diagnostic tests such as electromyography (EMG), magnetic resonance imaging (MRI), and ultrasound.

We performed a retrospective single-center study of 15 patients with clinically diagnosed TTS who underwent open decompression (2015-2022). All had failed conservative management and completed ≥ 12 months of follow-up. Preoperative evaluation combined clinical exams with at least one confirmatory test (EMG, MRI, or ultrasound). Outcomes included the American Orthopaedic Foot and Ankle Society's (AOFAS) ankle-hindfoot score (primary), Visual Analogue Scale (VAS) pain, minimal clinically important difference (MCID), and complications. The analysis used paired t -tests, Cohen's d, and analysis of covariance (ANCOVA), adjusting for baseline AOFAS, age, symptom duration, and EMG results.

The mean age was 50.4 ± 15.6 years; and 53.3% of the patients were female. Symptom duration averaged 14.7 ± 7.2 months. The EMG scans were positive in 66.7%, MRI in 60.0%, and ultrasound in 53.3%. The AOFAS score improved from 36.6 ± 7.1 to 78.1 ± 19.9 at 12 months ( p  < 0.001; d = 2.26), and VAS decreased from 7.0 ± 0.6 to 3.4 ± 1.3 ( p  < 0.001; d = -3.72). The MCID was achieved in 80% for AOFAS and 100% for VAS. Two minor complications (13.3%) occurred, without need for reoperations. The ANCOVA suggested trends for baseline severity and chronicity without significance.

Surgical decompression is a safe and effective treatment for TTS, providing significant pain relief and functional improvement with low complication rates. Early intervention shows a trend toward better outcomes, warranting further prospective studies.