Anatomical bases of endoscopic tarsal tunnel release: anatomical and ultra-sonographic study with a preliminary clinical report

Shazly, Ossama El; Shazly, Ayman El; Desouky, Ahmed; Zohiery, Abeer K. El; Sakr, Hossam Moussa

doi:10.1007/s00276-011-0890-y

Cited by 19 publications

(14 citation statements)

References 20 publications

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“…However, both open and endoscopic recessions still require epidural anesthesia, lower limb ischemia, and stitches. In addition, there is a real possibility of damaging the nerves and vessels, which is not under the complete control of the surgeon at all stages of the procedure . Ultrasound‐guided surgery is performed with 1‐ to 2‐mm incisions, without ischemia, and with local anesthesia as an outpatient surgery.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, there is a real possibility of damaging the nerves and vessels, which is not under the complete control of the surgeon at all stages of the procedure. [26][27][28] Ultrasound-guided surgery is performed with 1-to 2-mm incisions, without ischemia, and with local anesthesia as an outpatient surgery. It may provide more aesthetically pleasing scars and facilitate recovery, thus reducing the risk of infection, wound dehiscence, and postoperative perineural fibrosis.…”

Section: Discussionmentioning

confidence: 99%

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Ultrasound‐Guided Release of the Tibial Nerve and Its Distal Branches: A Cadaveric Study

Iborra¹,

Villanueva‐Martínez²,

Barrett³

et al. 2018

J of Ultrasound Medicine

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Objectives The purpose of the study was to determine whether ultrasound (US)‐guided surgery is a viable type of surgery for performing an effective release/decompression of the constricting structures that are responsible for focal nerve compression in tarsal tunnel syndrome. Methods Ultrasound guidance was used on cadaveric specimens to delineate the anatomic course of the nerves and vessels in the medial ankle that comprise the structures involved in tarsal tunnel syndrome. Ultrasound guidance was used on cadaveric specimens and assisted in delineating a safe surgical zone to adequately and effectively release these constrictive structures of the proximal and distal tarsal tunnels. The US‐guided tarsal tunnel release/decompression was performed through 2 small 1‐ to 2‐mm portals. After US‐guided release, anatomic dissection was used to check the efficacy (release of the flexor retinaculum and deep abductor hallucis muscle) and safety (absence of neurovascular or tendon injury) of the procedure. Results In 12 fresh cadaveric specimens, US‐guided release of the tibial nerve (proximal tarsal tunnel) and its branches (distal tarsal tunnel) at the medial ankle was effective in all 12 specimens (100% release rate), without any signs of compromise or injury into the neurovascular structures. Conclusions Ultrasound‐guided tarsal tunnel release is a feasible surgical procedure that can be safe and effective with the proper training, although further investigation is warranted. This type of surgery may promote faster recovery with less postoperative morbidity, including pain, but this will be the subject of a further investigation.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Ultrasound‐Guided Release of the Tibial Nerve and Its Distal Branches: A Cadaveric Study

Iborra¹,

Villanueva‐Martínez²,

Barrett³

et al. 2018

J of Ultrasound Medicine

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“…Variations in methods in the current literature give a variation in results and make the studies difficult to compare (11,12,(16)(17)(18)(19)(20)(21). For example, Lee and Dauphinée (11) found an increased CSA using ultrasound in patients with DPN (24 mm 2 ) compared with healthy control subjects (12 mm 2 ).…”

Section: Discussionmentioning

confidence: 99%

“…Four studies evaluated healthy individuals and describe CSAs between 7.9 and 13.7 mm 2 . All the CSAs were measured at different locations in the ankle (16)(17)(18)20 (12,21).…”

Section: Discussionmentioning

confidence: 99%

Ultrasound Findings After Surgical Decompression of the Tarsal Tunnel in Patients With Painful Diabetic Polyneuropathy: A Prospective Randomized Study

et al. 2014

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OBJECTIVEIt has been hypothesized that the development of diabetic polyneuropathy (DPN) is due to swelling of the nerve, as well as thickening and stiffening of the surrounding ligaments, causing chronic compression of nerves. We aimed to examine the effect of surgical decompression of the tibial nerve on the mean cross-sectional area (CSA). RESEARCH DESIGN AND METHODSWe performed a randomized controlled trial of 42 subjects with painful DPN diagnosed using the Diabetic Neuropathy Score. A computer randomized for the surgery arm of the study. A control group consisting of 38 healthy subjects was included. An experienced sonographer measured the CSA and thickness-to-width (T/W) ratio of the tibial nerve, as well as the thickness of the flexor retinaculum. RESULTSCSA is significantly larger in patients with painful DPN (8.4 6 3.9 mm 2 ) than in control subjects (6.4 6 1.3 mm 2 ), P = 0.007. The T/W ratio in patients with painful DPN is 0.64 and in control subjects 0.59, P = 0.03. Patients with DPN have a significantly thicker retinaculum (1.07 mm) than control subjects (0.84 mm), P < 0.001. Mean follow-up was 28.2 weeks (range 23-45). Difference between baseline and follow-up in the operated leg was 1.49 mm 2 and in the control leg 1.81 mm 2 , P = 0.674. CONCLUSIONSDecompression of the tibial nerve does not result in a significant difference between baseline and follow-up in CSA using ultrasound between the operated and control leg. Ultrasound measurements show a significantly increased CSA, a significantly thicker retinaculum, and a significantly increased T/W ratio in patients with painful DPN compared with healthy control subjects.

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“…Von den Autoren wird die Neurografie trotzdem empfohlen (Patel et al 2005 (El Shazly et al 2011;. Von den Autoren wird die Neurografie trotzdem empfohlen (Patel et al 2005 (El Shazly et al 2011;.…”

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Nervenkompressionssyndrome

2015

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Anatomical bases of endoscopic tarsal tunnel release: anatomical and ultra-sonographic study with a preliminary clinical report

Abstract: Case series study, Level IV.

Cited by 19 publications

References 20 publications

Ultrasound‐Guided Release of the Tibial Nerve and Its Distal Branches: A Cadaveric Study

Ultrasound‐Guided Release of the Tibial Nerve and Its Distal Branches: A Cadaveric Study

Ultrasound Findings After Surgical Decompression of the Tarsal Tunnel in Patients With Painful Diabetic Polyneuropathy: A Prospective Randomized Study

Nervenkompressionssyndrome

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