Neurovascular decompression for idiopathic tarsal tunnel syndrome: technical note
Michihiro Kohnoa, Hiroshi Takahashib, Hiromu Segawaa, Keiji Sanoa
a Department
of Neurosurgery, Fuji Brain Institute and Hospital, 270-12 Sugita,
Fujinomiya City, Shizuoka Prefecture, 418-0021, Japan, b Department of
Neurosurgery, Tokyo Metropolitan Neurological Hospital, 2-6-1,
Musashidai, Fuchu city, 183 Tokyo, Japan
Correspondence to: Dr Michihiro Kohno mkouno-nsu@umin.ac.jc
Received 24 August
1999 and in revised form 8 February 2000;
Accepted 17
February 2000
OBJECTIVE
The surgical
outcome of idiopathic tarsal tunnel syndrome (TTS) is reported to be
worse than that attributable to ganglion, tarsal coalition, or tumour,
and therefore further development in the surgical treatment for
idiopathic TTS is considered to be necessary. Here the efficacy of
neurovascular decompression for patients with idiopathic TTS is evaluated.
METHODSTwelve feet
from nine patients with idiopathic TTS were treated. The patients were
aged 52-78 years (mean 64.6 years), and all of them complained of pain
or dysaesthesia of the sole of the foot. The posterior tibial nerve was
freed from the attached arteriovenous complex (posterior tibial artery
and veins). The dissected nerve had a flattened appearance in all of
the patients, suggesting nerve compression by the adjacent
arteriovenous complex and superficially by the flexor retinaculum. A
graft of fat was inserted as both a cushion and an antiadhesive between
the vessels and the nerve to achieve neurovascular decompression.
RESULTSPatients on
whom neurovascular decompression was performed had resolution or
lessening of symptoms in their feet. Neither wound infection nor
recurrence of symptoms was found during the follow up period (mean 26.8 months).
CONCLUSIONNeurovascular
compression syndrome plays a part in idiopathic TTS, and adding
neurovascular decompression to resection of the flexor retinaculum is effective.
Keywords: idiopathic tarsal tunnel syndrome; neurovascular decompression; peripheral entrapment neuropathy; surgery
© 2000 by Journal of Neurology, Neurosurgery, and Psychiatry
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