Surgical decompression of posterior tibial nerve entrapment in the tarsal tunnel

Tarsal tunnel syndrome is entrapment neuropathy of the posterior tibial nerve or any of its branches at the posteromedial aspect of the ankle and foot. Its treatment possesses a controversial issue, when non operative means fail to resolve the problem, its surgical decompression with neurolysis of the nerve and its branches is mandatory. This is a prospective study of 26 patients with 36 Tarsal tunnel syndromes, at a mean age of 40 years range [23-57 years] . There were 6 male patients [23%] and 20 [77%] were females. The affected sides were [right = 12; left= 4; bilateral = 20 feet]. All the patients were presented after having been subjected to conservative treatment for varying periods of time which range from [12-36] months. Preoperatively the affection was clinically severe in 16 feet [44.4%] and moderate in 20[55.6%] as assessed clinically by the author and confirmed by electro-diagnostic studies using the modified pointing scoring system which proposed by Dellon et al. All the feet were treated by surgical decompression of tarsal tunnel with neuro lysis of the posterior tibial nerve and its branches . At mean follow-up period of 20 months which ranges from [15-30 months] the result was satisfactory in 33feet [91.6%] and 3[8.4%] were unsatisfactory. When the follow up overall mean scores of clinical and electrodiagnostic studies were investigated showed that there are significant positive linear improvement than those of the preoperative scores of clinical and nerve conduction studies.This was reflected clinically to the improvement of the patients daily activity to normal or nearly normal life style. This study suggests that early decompression of the posterior tibial nerve and neurolysis of its branches is mandatory when non operative means fail to resolve the problem

Anomalous arrangement of structures in the popliteal fossa and its clinical significance

The anatomical knowledge of arrangement of the structures in popliteal fossa is important for any surgical and angiographic procedures. In the popliteal fossa, the usual arrangement of structures from superficial to deep is: the tibial nerve, popliteal vein and the popliteal artery, respectively. Considering the fact that there is a paucity of literature in the description of unusual arrangement of these structures in the popliteal fossa, the present study assumes much significance both academically and clinically. We dissected both sides of 50 lower limbs [n=50] of embalmed cadavers in the department of anatomy, to study the relationship of the tibial nerve, popliteal vein and the popliteal artery Only in once case, we detected the tibial nerve to be most superficial as usual but the popliteal artery was found to lie deep to the tibial nerve, with the popliteal vein lying still deeper to it. Thus, the normal arrangement of the tibial nerve, popliteal vein and the popliteal artery being arranged from superficial to deep, was not observed Topographical anatomical knowledge of the arrangement of the structures in the popliteal fossa are important to check inadvertent injuries during any surgery. Abnormal position of the blood vessels in the popliteal region may also lead to faulty administration of dyes in angiographic procedures and erroneous interpretation of angiograms