Prevalence of Obesity in High Tarsal Tunnel Syndrome: A Cross-Sectional Study.

BACKGROUND: Tarsal tunnel syndrome (TTS) occurs when an individual suffers from tibial nerve compression at the tarsal tunnel. Symptoms of TTS may include pain, burning, or tingling on the bottom of the foot and into the toes. Tarsal tunnel syndrome can be divided into distal and proximal TTS. Furthermore, a high tarsal tunnel syndrome (HTTS) has also been described as a fascial entrapment proximal to the laciniate ligament at the level of the high ankle. Multiple risk factors, including obesity, have been said to be associated with TTS. This study aimed to determine the frequency of obesity in the form of body mass index (BMI) with HTTS. METHODS: A cross-sectional descriptive study using a nonprobability sampling method retrospectively surveyed the BMI of 73 patients whose clinical presentation suggested HTTS or TTS, and in which electrodiagnostic testing found HTTS. The age of the patients ranged from 25 to 90 years (mean, 56.4 years). Thirty-five patients were men and 38 patients were women. RESULTS: Based on BMI, nine patients with HTTS had normal weight (12.9%), 17 patients were overweight (23.3%), and the remaining 47 patients were obese (64.3%). CONCLUSIONS: The frequency of obesity in the form of BMI was 64.3% in patients with HTTS, which is a significantly high correlation.

Tarsal tunnel syndrome secondary to accessory or variant muscles: a clinical and anatomical systematic review.

PURPOSE: Many etiologies are known to lead to a tarsal tunnel syndrome (TTS). One rare cause is mass-occupying lesions, and particularly accessory or variant muscles (AVM). This study aimed to systematically collect published clinical cases of TTS caused by AVM. METHODS: An electronic literature search was conducted from inception to April 2021. The diagnosis of AVM should be reported in one of the following methods: ultrasonography, magnetic resonance imaging (MRI), or per-operatively. Data extraction included types and prevalence of accessory muscles, clinical presentation and diagnosis, and treatment modalities. Twenty-five studies were identified with a total 39 patients (47 ankles). RESULTS: The prevalence of TTS was reported in only two studies (9%). Forty-nine AVM were identified with the accessory flexor digitorum longus being the most common (52%). The most common sign/symptoms were tenderness (78.7%), pain (82.9%), dysesthesia (57.4%), Tinel sign (44.6%), and a swelling (25.5%). Decompression and excision were the most commonly performed procedures. Four accessory/variant muscles in the ankle have the potential to induce a tarsal tunnel syndrome. CONCLUSION: This review highlights the clinical and imagery specificities of TTS secondary to accessory or variant muscles. Mass-occupying etiology should be included in the list of differential diagnoses whenever a posterior tibial nerve compression is suspected.

Outcome of neurolysis for failed tarsal tunnel surgery.

Revision tarsal tunnel surgery was performed on 44 patients (two bilaterally). The surgical procedure included a neurolysis of the tibial nerve in the tarsal tunnel, the medial plantar, lateral plantar, and calcaneal nerves in their respective tunnels, excision of the intertunnel septum, and neuroma resection as indicated. A painful tarsal tunnel scar or painful heel was treated, respectively, by resection of the distal saphenous nerve or a calcaneal nerve branch. Postoperative, immediate ambulation was permitted. Outcomes were assessed with a numerical grading scale that included neurosensory measurements. Outcomes were also assessed by patient satisfaction and their own estimate of residual pain and/or numbness. Mean follow-up time was 2.2 years. Outcomes in terms of patient satisfaction were 54% excellent, 24% good, 13% fair, and 9% poor results. The mean preoperative numerical score was 6.0 and the mean postoperative score was 2.7. There was a significant improvement seen, based on the median difference between scores (P<0.001). Prognostic indicators of poor results in our patient group were coexisting lumbosacral disc disease and/or neuropathy. An approach related to resecting painful cutaneous nerves and neurolysis of all tibial nerve branches at the ankle offers hope for relief of pain and recovery of sensation for the majority of patients with failed previous tarsal tunnel surgery.

Tarsal tunnel syndrome in athletes.

BACKGROUND: The details of the occurrence of tarsal tunnel syndrome in athletes have not been well documented in the literature, and more data on tarsal tunnel syndrome related to sporting activity are necessary to enable better recognition of this condition. HYPOTHESIS: Sporting activities make athletes vulnerable to the occurrence of tarsal tunnel syndrome under specific conditions. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Between 1986 and 2002, 18 patients with tarsal tunnel syndrome related to sporting activities were surgically treated, of whom 15 patients (21 feet; mean age, 17.8 years) were competitive athletes and 3 were recreational sports amateurs (4 feet; mean age, 52.7 years). To assess the role of physical factors and sporting activities in making athletes vulnerable to the occurrence of tarsal tunnel syndrome, the authors reviewed the medical charts and evaluated the results of treatment. The mean duration of follow-up was 58.6 months. RESULTS: Activities that triggered tarsal tunnel syndrome were those that applied a heavy burden on the ankle joint such as sprinting, jumping, and performing ashibarai in judo under specific physical conditions. Predisposing underlying physical factors were flatfoot deformity and an existence of talocalcaneal coalition, accessory muscles, and bony fragments around the tarsal tunnel. The majority of patients were able to return to the same sport after treatment. CONCLUSION: Tarsal tunnel syndrome occurs in athletes involved in strenuous sporting activities, especially when predisposing physical factors are present.

Backpacking-induced paresthesias.

OBJECTIVE: To evaluate the presence of numbness and paresthesias among long-distance backpackers on the Appalachian Trail. METHODS: Backpackers who hiked a minimum of 7 days were interviewed while hiking. Following their hike, a written questionnaire was mailed to the participants that explored the incidence of injuries and illnesses among hikers. Paresthesias were defined as either numbness or "phantom, burning, or shooting pains." A case-control analysis of risk factors for paresthesias was performed. RESULTS: Paresthesias were reported by 34% (96 of 280) of the backpackers completing the study. They included ulnar paresthesias (n = 4), meralgia paresthetica (n = 10), tarsal tunnel syndrome (n = 6), digitalgia paresthetica (n = 21), and nonspecific paresthesias (n = 61). The most common symptom was numbness: 81% (78 of 96). Significant risk factors included a distance of >2000 miles (relative risk [RR] = 1.3; 95% CI, 1.1-1.6; P = .01) and the duration of hiking (RR = 2.0; 95% CI, 1.2-3.2; P = .004) for the longest quartile. Nonsignificant factors included backpack weight, initial body weight, percentage of weight loss, running shoe usage, and multivitamin usage. Ninety-eight percent of the paresthesias (94 of 96) had resolved by the time of follow-up (median = 30 days). CONCLUSIONS: Paresthesias were a surprisingly common complaint among long-distance backpackers. Although they were distressing during backpacking, these neuropathies were self-limited and resolved after completion of hiking.

Tarsal tunnel syndrome. Comprehensive review of 87 cases.

The results of the study indicate that tarsal tunnel syndrome is a pathologic condition in which there are multiple etiologies, which in some cases are poorly defined. In order to arrive at a definitive diagnosis, all available tests, including pathology reports, are important. Where proper diagnosis is made and followed with appropriate adjunctive care, the probability of recurrence will be minimized. Statistical information in itself is of some value, because it may help the podiatrist to more clearly diagnose and treat the patients in whom vague or general symptoms may exist.