Síndrome del túnel del tarso: análisis clínico-imagenológico de una serie de casos / Tarsal tunnel syndrome: Clinical-imaging analysis of a case series

Antecedentes: Revisión retrospectiva de pacientes con diagnóstico de síndrome del túnel del tarso (STT) tratados quirúrgicamente. Método: Serie retrospectiva de pacientes con diagnóstico de STT operados entre los años 2005 y 2020 en un mismo centro. Se analizan variables como edad, género, lado, nervio o rama afectada, clasificación, tipo de estudio imagenológico, resultado biopsia, tasa de infección, tasa recurrencia, secuelas, entre otras. Resultados: Se incluyen ocho hombres y dos mujeres con edad promedio de 47 años (rango 34-67) y seguimiento promedio de 62,2 meses (rango 2-149). Todos los casos se relacionan con una compresión intrínseca. La causa más frecuente fue la presencia de quiste (40%), seguida de adherencias perineurales (20%). El nervio tibial posterior fue el más afectado (50%) y 30% la rama plantar medial. La ecografía (70%) y resonancia magnética (50%) fueron los estudios más solicitados. No hubo casos de infección postoperatoria. Hubo tres pacientes que presentaron recurrencia de la lesión requiriendo una nueva cirugía. Conclusiones: El STT es una neuropatía que compromete al nervio tibial posterior o a algunas de sus ramas. En general su causa es la compresión del nervio por distintas estructuras como músculos accesorios, gangliones, entre otras. El diagnóstico es eminentemente clínico apoyándose en estudio por imágenes. El tratamiento quirúrgico presenta mejores resultados cuando la causa es una compresión intrínseca, aunque se describen tasas variables de recurrencia.(AU)

Background: Retrospective review of patients with a diagnosis of Tarsal Tunnel Syndrome (TTS) treated surgically. Methods: Retrospective series of patients with diagnosis of TTS operated between 2005 and 2020 in the same center. Variables such as age, sex, side, affected nerve or branch, classification, type of imaging study, biopsy result, infection rate, recurrence rate, sequelae, among others, were analyzed. Results: We included 8 men and 2 women with an average age of 47 years (range 34-67) and an average follow-up of 62.2 months (range 2-149). All cases were related to intrinsic compression. The most frequent cause was the presence of cyst (40%) followed by perineural adhesions (20%). The Posterior Tibial Nerve was the most affected (50%) and 30% the Medial Plantar Branch. Ultrasound (70%) and MRI (50%) were the most requested studies. There were no cases of postoperative infection. There were 3 patients who presented recurrence of the lesion requiring a new surgery. Conclusions: TTS is a neuropathy involving the posterior tibial nerve or some of its branches. In general, it is caused by compression of the nerve by different structures such as accessory muscles and ganglions, among others. The diagnosis is eminently clinical, supported by imaging studies. Surgical treatment presents better results when the cause is an intrinsic compression, although variable recurrence rates are described.(AU)

Tarsal tunnel syndrome: Clinical-imaging analysis of a case series / Síndrome del túnel del tarso: análisis clínico-imagenológico de una serie de casos

Background: Retrospective review of patients with a diagnosis of Tarsal Tunnel Syndrome (TTS) treated surgically. Methods: Retrospective series of patients with diagnosis of TTS operated between 2005 and 2020 in the same center. Variables such as age, sex, side, affected nerve or branch, classification, type of imaging study, biopsy result, infection rate, recurrence rate, sequelae, among others, were analyzed. Results We included 8 men and 2 women with an average age of 47 years (range 34-67) and an average follow-up of 62.2 months (range 2-149). All cases were related to intrinsic compression. The most frequent cause was the presence of cyst (40%) followed by perineural adhesions (20%). The Posterior Tibial Nerve was the most affected (50%) and 30% the Medial Plantar Branch. Ultrasound (70%) and MRI (50%) were the most requested studies. There were no cases of postoperative infection. There were 3 patients who presented recurrence of the lesion requiring a new surgery. Conclusions: TTS is a neuropathy involving the posterior tibial nerve or some of its branches. In general, it is caused by compression of the nerve by different structures such as accessory muscles and ganglions, among others. The diagnosis is eminently clinical, supported by imaging studies. Surgical treatment presents better results when the cause is an intrinsic compression, although variable recurrence rates are described.(AU)

Antecedentes: Revisión retrospectiva de pacientes con diagnóstico de síndrome del túnel del tarso (STT) tratados quirúrgicamente. Método: Serie retrospectiva de pacientes con diagnóstico de STT operados entre los años 2005 y 2020 en un mismo centro. Se analizan variables como edad, género, lado, nervio o rama afectada, clasificación, tipo de estudio imagenológico, resultado biopsia, tasa de infección, tasa recurrencia, secuelas, entre otras. Resultados: Se incluyen ocho hombres y dos mujeres con edad promedio de 47 años (rango 34-67) y seguimiento promedio de 62,2 meses (rango 2-149). Todos los casos se relacionan con una compresión intrínseca. La causa más frecuente fue la presencia de quiste (40%), seguida de adherencias perineurales (20%). El nervio tibial posterior fue el más afectado (50%) y 30% la rama plantar medial. La ecografía (70%) y resonancia magnética (50%) fueron los estudios más solicitados. No hubo casos de infección postoperatoria. Hubo tres pacientes que presentaron recurrencia de la lesión requiriendo una nueva cirugía. Conclusiones: El STT es una neuropatía que compromete al nervio tibial posterior o a algunas de sus ramas. En general su causa es la compresión del nervio por distintas estructuras como músculos accesorios, gangliones, entre otras. El diagnóstico es eminentemente clínico apoyándose en estudio por imágenes. El tratamiento quirúrgico presenta mejores resultados cuando la causa es una compresión intrínseca, aunque se describen tasas variables de recurrencia.(AU)

Tarsal tunnel syndrome: Clinical-imaging analysis of a case series. / Síndrome del túnel del tarso: análisis clínico-imagenológico de una serie de casos.

BACKGROUND: Retrospective review of patients with a diagnosis of Tarsal Tunnel Syndrome (TTS) treated surgically. METHODS: Retrospective series of patients with diagnosis of TTS operated between 2005 and 2020 in the same center. Variables such as age, sex, side, affected nerve or branch, classification, type of imaging study, biopsy result, infection rate, recurrence rate, sequelae, among others, were analyzed. RESULTS: We included 8 men and 2 women with an average age of 47 years (range 34-67) and an average follow-up of 62.2 months (range 2-149). All cases were related to intrinsic compression. The most frequent cause was the presence of cyst (40%) followed by perineural adhesions (20%). The Posterior Tibial Nerve was the most affected (50%) and 30% the Medial Plantar Branch. Ultrasound (70%) and MRI (50%) were the most requested studies. There were no cases of postoperative infection. There were 3 patients who presented recurrence of the lesion requiring a new surgery. CONCLUSIONS: TTS is a neuropathy involving the posterior tibial nerve or some of its branches. In general, it is caused by compression of the nerve by different structures such as accessory muscles and ganglions, among others. The diagnosis is eminently clinical, supported by imaging studies. Surgical treatment presents better results when the cause is an intrinsic compression, although variable recurrence rates are described.

Tarsal tunnel syndrome-A narrative literature review.

BACKGROUND: Tarsal tunnel syndrome is classified as a focal compressive neuropathy of the posterior tibial nerve or one of its associated branches individually or collectively. The tunnel courses deep to fascia, the flexor retinaculum and within the abductor hallucis muscle of the foot/ankle. The condition is rare and regularly under-diagnosed leading to a range of symptoms affecting the plantar margins of the foot. There are many intervention strategies for treating tarsal tunnel syndrome with limited robust evidence to guide the clinical management of this condition. The role of conservative versus surgical interventions at various stages of the disease process remains unclear, and there is a need for a structured, step-wise approach in treating patients with this syndrome based on derived empirical evidence. This narrative review attempts to scrutinize the literature to date by clarifying initial presentation, investigations and definitive treatment for the purpose of assisting future informed clinical decision and prospective research endeavours. PROCESS: The literature searches that have been incorporated in compiling a rigorous review of this condition have included: the Cochrane Neuromuscular Group's Specialized Register (Cochrane Library 2013), the databases of EMBASE, AMED, MEDLINE, CINAHL, Physiotherapy evidence database (PEDRO), Biomed Central, Science Direct and Trip Database (1972 to the present). Reference listings of located articles were also searched and scrutinized. Authors and experts within the field of lower-limb orthopaedics were contacted to discuss applicable data. Subject-specific criteria searches utilizing the following key terms were performed across all databases: tarsal tunnel syndrome, tibial neuralgia, compression neuropathy syndromes, tibial nerve impingement, tarsal tunnel neuropathy, entrapment tibial nerve, posterior tibial neuropathy. These search strategies were modified with differing databases, adopting specific sensitivity-searching tools and functions unique to each. This search strategy identified 88 journal articles of relevance for this narrative literature review. FINDINGS: This literature review has appraised the clinical significance of tarsal tunnel syndrome, whilst assessing varied management interventions (non-surgical and surgical) for the treatment of this condition in both adults and children. According to our review, there is limited high-level robust evidence to guide and refine the clinical management of tarsal tunnel syndrome. Requirements for small-scaled randomized controlled trials in groups with homogenous aetiology are needed to analyse the effectiveness of specific treatment modalities. CONCLUSIONS: It is necessary that further research endeavours be pursued for the clinical understanding, assessment and treatment of tarsal tunnel syndrome. Accordingly, a structured approach to managing patients who have been correctly diagnosed with this condition should be formulated on the basis of empirical evidence where possible.