Touch pressure and sensory density after tarsal tunnel release in diabetic neuropathy.

BACKGROUND: Limited quantitative information is available about the improvement of protective sensation after tarsal tunnel release in patients with diabetic peripheral neuropathy. METHODS: Prospective, non-blinded, non-randomized case series of 10 feet in 8 diabetic patients and 24 feet in 22 non-diabetic patients who had tarsal tunnel release. Preoperative and postoperative (average, 8-9 months) anatomic, quantitative sensory testing was done with touch pressure 1-point threshold (Semmes-Weinstein monofilaments) and 2-point discrimination. RESULTS: There was marked, significant postoperative improvement of mean touch pressure 1-point threshold, compared with preoperative values, for medial calcaneal, medial plantar, and lateral plantar nerves in both non-diabetic and diabetic patients. There was minimal improvement in 2-point discrimination only for the medial calcaneal nerve in non-diabetic, but not in diabetic, patients. CONCLUSIONS: Nerve entrapment at the tarsal tunnel is an important component of diabetic peripheral neuropathy. Tarsal tunnel decompression may improve sensory impairment and restore protective sensation.

A touch pressure sensory assessment of the surgical treatment of the tarsal tunnel syndrome.

BACKGROUND: Decompressive tarsal tunnel surgery may improve dysfunctional plantar foot sensation in, patients with tarsal tunnel syndrome and peripheral neuropathy. However, quantitative sensory, assessment is lacking. METHOD: Quantitative sensory threshold evaluation of 42 feet in 37 consecutive (29 non-diabetic and 8 diabetic) patients was done before and after surgical decompression for tarsal tunnel syndrome. Insensitivity was documented quantitatively (grams force) before and after surgery using a graded series of twenty Semmes-Weinstein monofilaments applied to the anatomic nerve regions of the plantar aspect of the foot. RESULTS: Sensory evaluation at an average of 12 months after surgery showed significant improvement, of mean sensory threshold, compared with preoperative values, for medial calcaneal, medial plantar, and lateral plantar nerves. CONCLUSION: Quantitative sensory assessment with a graded series of twenty Semmes-Weinstein, monofilaments showed significant sensory improvement in the medial calcaneal, medial plantar, and, lateral plantar nerves after posterior tibial nerve decompression.

Tarsal tunnel syndrome: assessment of treatment outcome with an anatomic pain intensity scale.

BACKGROUND: Assessment of treatment outcomes for tarsal tunnel syndrome may be improved with a standardized pain rating scale using a descriptive anatomical foot model for pretreatment and post-treatment plantar foot pain analysis. METHODS: Prospective evaluation of 46 consecutive patients (56 feet) who had non-operative and surgical treatment for tarsal tunnel syndrome. Pain intensity was documented before and after treatment with the Wong-Baker FACES Pain Rating Scale applied to the anatomic nerve regions of the plantar aspect of the foot. RESULTS: In patients who had successful non-operative treatment, overall pain intensity was significantly improved in the medial calcaneal, medial plantar, and lateral plantar nerve regions. In patients who had ongoing symptoms despite non-operative treatment, surgical treatment resulted in significant pain improvement in the medial calcaneal and medial plantar, but not lateral plantar, nerve regions. Pretreatment motor nerve conduction latency was significantly greater in patients who had surgical treatment than those who had only non-operative treatment. CONCLUSIONS: Anatomic pain intensity rating models may be useful in the pretreatment and follow-up evaluation of tarsal tunnel syndrome. Predictors of failed non-operative treatment included longer motor nerve conduction latency and greater predominance of foot comorbidities.

An outcomes analysis of surgical treatment of tarsal tunnel syndrome.

Sixty patients (68 feet) underwent tarsal tunnel release for the tarsal tunnel syndrome and were re-examined objectively and clinically after they had reached maximum medical benefits and returned to their usual and customary lifestyle and employment. All of the patients demonstrated both a positive tinel sign and an abnormal motor nerve conduction velocity measurement. As determined objectively, there was 85% complete symptom relief. As determined subjectively, there was 51% symptom relief. Additionally, there was significant improvement in the quality of work, job productivity, and interpersonal relationships. There was a clinical dichotomy, however, between the objective pain relief measurement in contrast to the subjective patient's assessment.