Vascular Supply of Nerves in the Tarsal Tunnel

1997 ◽  
Vol 18 (5) ◽  
pp. 288-292 ◽  
Author(s):  
David C. Flanigan ◽  
Martin Cassell ◽  
Charles L. Saltzman
Keyword(s):  
Tibial Nerve ◽  
Posterior Tibial Artery ◽  
Vascular Supply ◽  
Tarsal Tunnel ◽  
Lateral Plantar Nerve ◽  
Nutrient Artery ◽  
Vascular Compromise ◽  
Tunnel Syndrome ◽  
Nutrient Vessel ◽  
Branching Point

The normal vascular supply of nerves in the tarsal tunnel was studied by intra-arterial injection of latex. In general, the blood supply to the tibial nerve and its branches came directly from corresponding arteries. Each nutrient artery to the tibial nerve bifurcated on the surface of the lateral plantar nerve fasciculus to create longitudinal vessels that made anastomoses with bifurcating nutrient vessels proximally and distally. This primary longitudinal system supplied intersubfascicular vessels to the medial plantar fasciculus. The last nutrient artery from the posterior tibial artery usually supplied the terminal branching point of the tibial nerve midway through the tarsal tunnel. The lateral and medial plantar nerves received most of the nutrient vessels from their corresponding arteries in shorter intervals. In 65% of cases, the lateral plantar nerve received a nutrient vessel from the medial plantar artery. Potential anatomical areas of vascular compromise in the etiology or surgical release of tarsal tunnel syndrome are discussed.

scholarly journals Predictive Outcome Modeling of Preoperative Clinical Symptoms and Electrodiagnostic Data in Tarsal Tunnel Surgery

2021 ◽  
Vol 16 (01) ◽  
pp. e37-e45
Author(s):  
Geoffrey K. Seidel ◽  
Salma Al Jamal ◽  
Eric Weidert ◽  
Frederick Carington ◽  
Michael T. Andary ◽  
...  
Keyword(s):  
Surgical Outcome ◽  
Clinical Symptoms ◽  
Tibial Nerve ◽  
Outcome Measurement ◽  
Tarsal Tunnel ◽  
Patient Reported ◽  
Peripheral Polyneuropathy ◽  
Tunnel Syndrome ◽  
Phalen's Test ◽  
Surgical Release

Abstract Background The relationship between tarsal tunnel syndrome (TTS), electrodiagnostic (Edx) findings, and surgical outcome is unknown. Analysis of TTS surgical release outcome patient satisfaction and comparison to Edx nerve conduction studies (NCSs) is important to improve outcome prediction when deciding who would benefit from TTS release. Methods Retrospective study of 90 patients over 7 years that had tarsal tunnel (TT) release surgery with outcome rating and preoperative tibial NCS. Overall, 64 patients met study inclusion criteria with enough NCS data to be classified into one of the following three groups: (1) probable TTS, (2) peripheral polyneuropathy, or (3) normal. Most patients had preoperative clinical provocative testing including diagnostic tibial nerve injection, tibial Phalen's sign, and/or Tinel's sign and complaints of plantar tibial neuropathic symptoms. Outcome measure was percentage of patient improvement report at surgical follow-up visit. Results Patient-reported improvement was 92% in the probable TTS group (n = 41) and 77% of the non-TTS group (n = 23). Multivariate modeling revealed that three out of eight variables predicted improvement from surgical release, NCS consistent with TTS (p = 0.04), neuropathic symptoms (p = 0.045), and absent Phalen's test (p = 0.001). The R 2 was 0.21 which is a robust result for this outcome measurement process. Conclusion The best predictors of improvement in patients with TTS release were found in patients that had preoperative Edx evidence of tibial neuropathy in the TT and tibial nerve plantar symptoms. Determining what factors predict surgical outcome will require prospective evaluation and evaluation of patients with other nonsurgical modalities.

Tarsal Tunnel Syndrome Associated with a Pulsating Artery

2010 ◽  
Vol 100 (3) ◽  
pp. 209-212 ◽  
Author(s):  
Eunkuk Kim ◽  
Martin K. Childers
Keyword(s):  
High Resolution ◽  
Ultrasound Imaging ◽  
Tibial Nerve ◽  
Tarsal Tunnel ◽  
Posterior Tibial Nerve ◽  
Tarsal Tunnel Syndrome ◽  
Ultrasound Guided ◽  
Nerve Ultrasound ◽  
Posterior Tibial ◽  
Tunnel Syndrome

We describe a patient with tarsal tunnel syndrome in whom ultrasound imaging revealed compression of the posterior tibial nerve by a pulsating artery. High-resolution ultrasound showed a round pulsating hypoechoic lesion in contact with the posterior tibial nerve. Ultrasound-guided injection of 0.5% lidocaine temporarily resolved the paresthesia. These findings suggest an arterial etiology of tarsal tunnel syndrome. (J Am Podiatr Med Assoc 100(3): 209–212, 2010)

Tibial Neuropathy—Tarsal Tunnel Syndrome

2018 ◽  
Author(s):  
Daniel A. Lyons ◽  
David L. Brown
Keyword(s):  
Physical Examination ◽  
Surgical Intervention ◽  
Tibial Nerve ◽  
Clinical History ◽  
Surgical Decompression ◽  
Tarsal Tunnel ◽  
Success Rates ◽  
Tarsal Tunnel Syndrome ◽  
Tunnel Syndrome ◽  
Space Occupying Lesion

Tarsal tunnel syndrome (TTS) is caused by compression of the tibial nerve and its branches within the tarsal tunnel at the ankle. The diagnosis of TTS is often made clinically, but imaging and electrodiagnostic studies should be considered when the diagnosis cannot be ascertained from the clinical history and physical examination. Surgical decompression of the tarsal tunnels should be pursued only after conservative measures have failed or when a space-occupying lesion or point of tibial nerve compression has been identified. Surgical intervention requires complete release of the flexor retinaculum at the medial ankle, as well as release of the three distinct tunnels enveloping the medial and lateral plantar nerves and the calcaneal branch. Success rates for tibial nerve decompression vary widely in the literature, ranging from 44% to 96%.

scholarly journals Surgical Treatment of Tarsal Tunnel Syndrome - Case Report

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
EL Maqrout A ◽  
◽  
Fekhaoui MR ◽  
Boufettal M ◽  
Bassir RA ◽  
...  
Keyword(s):  
Tibial Nerve ◽  
Annular Ligament ◽  
Tarsal Tunnel ◽  
Posterior Tibial Nerve ◽  
Tarsal Tunnel Syndrome ◽  
Total Recovery ◽  
After Effects ◽  
Intensive Training ◽  
Posterior Tibial ◽  
Tunnel Syndrome

The first description of tarsal tunnel syndrome is recent. Koppel in 1960 evoked the after-effects of lesions of the posterior tibial nerve. Keck in 1969 was the first to describe compression of the posterior tibial nerve by the internal annular ligament. It was a young soldier who, after intensive training, had bilateral plantar anesthesia. The opening of the internal annular ligament had allowed a total recovery in 48 hours. Our objective here is to discuss the circumstances of the diagnosis of this syndrome, to analyze its anatomical and pathological causes, to present the types of treatments followed, in the light of the literature.

Ultrasound-Guided Proximal and Distal Tarsal Decompression: An Analysis of Pressures in the Tarsal, Medial Plantar, and Lateral Plantar Tunnels

2020 ◽  
pp. 193864002090542
Author(s):  
Alvaro Iborra Marcos ◽  
Manuel Villanueva Martinez ◽  
Pablo Sanz-Ruiz ◽  
Stephen L. Barrett ◽  
George Zislis
Keyword(s):  
Tibial Nerve ◽  
Tarsal Tunnel ◽  
Ultrasound Guided ◽  
Intracompartmental Pressure ◽  
Level Of Evidence ◽  
Mean Values ◽  
Guided Surgery ◽  
Novel Approach ◽  
Before And After ◽  
Tunnel Syndrome

Objectives. To analyze the reliability of measurements of tarsal tunnel and medial and lateral plantar tunnel pressures before and after ultrasound-guided release. Measurements taken were guided by ultrasound to improve reliability. This novel approach may help surgeons make surgical decisions. The second objective was to confirm that decompression using ultrasound-guided surgery as previously described by the authors is technically effective, reducing pressure to the tarsal and medial and lateral plantar tunnels. Methods. The study included 23 patients with symptoms compatible with idiopathic tarsal tunnel syndrome (TTS). The first step was to measure intracompartmental pressure of the tarsal tunnel, medial plantar tunnel, and lateral plantar tunnel preoperatively. The second step was ultrasound-guided decompression of the tibial nerve and its branches. Subsequently, pressure was measured again immediately after decompression in the 3 tunnels. Results. After surgery, the mean values significantly dropped to normal values. This represents a validation of effective decompression of the tibial nerve and its branches in TTS with ultra–minimally invasive surgery. Conclusions. The ultrasound-guided surgical technique to release the tibial nerve and its branches is effective, significantly reducing pressure in the tunnels and, thereby, decompressing the nerves. Level of evidence: Level IV

Tarsal Tunnel Syndrome Caused by an Occult Schwannoma of the Posterior Tibial Nerve: Avoidance of Delay in Diagnosis

2021 ◽  
Vol 111 (1) ◽  
Author(s):  
Mehmet Burak Yalcin ◽  
Utku Erdem Ozer
Keyword(s):  
Peripheral Nerves ◽  
Tibial Nerve ◽  
Tarsal Tunnel ◽  
Posterior Tibial Nerve ◽  
Tarsal Tunnel Syndrome ◽  
Significant Delay ◽  
Delay In Diagnosis ◽  
Posterior Tibial ◽  
Entrapment Neuropathies ◽  
Tunnel Syndrome

Tarsal tunnel syndrome (TTS), resulting from compression of the posterior tibial nerve (PTN) within the tarsal tunnel, is a relatively uncommon entrapment neuropathy. Many cases of tarsal tunnel syndrome are idiopathic; however, some causes, including space-occupying lesions, may lead to occurrence of TTS symptoms. Schwannoma, the most common tumor of the sheath of peripheral nerves, is among these space-occupying lesions, and may cause TTS when it arises within the tarsal tunnel, and it may mimic TTS even when it is located outside the tarsal tunnel and cause a significant delay in diagnosis. The possibility of an occult space-occupying lesion compressing the PTN should be kept in mind in the differential diagnosis of TTS, and imaging studies that are usually not used in entrapment neuropathies may be of importance in such patients. This case report presents a 65-year-old woman with TTS symptoms and neurophysiologic findings secondary to an occult schwannoma of the PTN proximal to the tarsal tunnel. Avoidance of delay in diagnosis in secondary cases is emphasized.

The Effects of Foot Position and Load on Tibial Nerve Tension

1998 ◽  
Vol 19 (2) ◽  
pp. 73-78 ◽  
Author(s):  
Tim R. Daniels ◽  
John Tak-Choy Lau ◽  
Trevor C. Hearn
Keyword(s):  
Internal Rotation ◽  
Tibial Nerve ◽  
Surgical Decompression ◽  
Unknown Etiology ◽  
Tarsal Tunnel ◽  
Tarsal Tunnel Syndrome ◽  
Pes Planus ◽  
Cyclical Load ◽  
Tunnel Syndrome ◽  
Foot Position

Patients with tarsal tunnel syndrome of unknown etiology do poorly after surgical decompression. Although surgical decompression addresses the soft tissue constraints, it ignores the role of osseous support. Some authors have suggested that a pes planus deformity (i.e., valgus hindfoot and abducted forefoot) is an unrecognized cause of tarsal tunnel syndrome due to increased tibial nerve tension. An in vitro study was performed on nine cadaveric feet to determine the effects of foot position and load on tibial nerve tension. Tensile forces placed through the tibial nerve were measured when the foot was placed in dorsiflexion, eversion, combined dorsiflexion-eversion, and then under cyclical load and increasing internal rotation at 5° increments from 0° to 20°. The nerve tension was reassessed after the creation of a pes planus deformity under the previous conditions. Tibial nerve tension in the stable and unstable foot was significantly increased by eversion, dorsiflexion, and combined dorsiflexion-eversion. Tibial nerve tension was significantly greater in an unstable foot when compared with a stable foot during eversion, dorsiflexion, and combined dorsiflexion-eversion. In the stable foot, tibial nerve tension was significantly increased during axial loading with increasing internal rotation when compared with 0° rotation. The increased tibial nerve tension in the stable foot was significant with increasing internal rotation when 0° was compared with 10°, 15°, and 20°. In the unstable foot, the tibial nerve tension was significantly increased with increasing internal rotation compared with the nerve tension at 0° of rotation. The increased tibial nerve tension in the unstable foot was significant with increasing internal rotation when 0° was compared with 5°, 10°, 15°, and 20°. When stability of the foot and internal rotation were compared independently, each factor increased tibial nerve tension. However, these factors acting together did not significantly compound the increase in nerve tension. This study demonstrates that tibial nerve tension is increased in an unstable foot compared with a stable foot during eversion, dorsiflexion, combined dorsiflexion-eversion, and cyclical load with increasing internal rotation.

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