Surgical decompression of posterior tibial nerve entrapment in the tarsal tunnel

ABSTRACT

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: