Effects of Tarsal Tunnel Release and Stabilization Procedures on Tibial Nerve Tension in a Surgically Created Pes Planus Foot

Abstract

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Posterior Tarsal Tunnel Syndrome

“…Factors associated with poor results include advanced age, chronic symptoms with motor deficits, epineural scarring of the tibial nerve, idiopathic cases, and inadequate splitting of the tarsal tunnel (23). Patients performing intense manual labor and those with recurrent tarsal tunnel syndrome have worse outcomes (15).…”

Biomechanical Evaluation of Two Clinical Tests for Plantar Heel Pain: The Dorsiflexion-Eversion Test for Tarsal Tunnel Syndrome and the Windlass Test for Plantar Fasciitis

“…4 Our findings regarding the increase in strain in the tibial nerve and LPN with combined dorsiflexion-eversion are in agreement with previous studies. 12,22 Using fresh frozen cadavers, Daniels et al 12 measured the tension in the LPN at the tarsal tunnel and reported an increase in tension of 13.2 N. In a later study, Lau and Daniels 22 found a 25 N increase in tension in the tibial nerve at the tarsal tunnel with combined dorsiflexion-eversion. In the present study, we demonstrated that the strain associated with combined dorsiflexion-eversion could be further increased with the addition of extension of the MTP joints.…”

Tarsal tunnel syndrome – the effect of the associated features on outcome of surgery

“…They also noted that recovery may be expected with immobilisation in the neutral position, as in this position there is no increase in pressure within the tunnel. Lau [13] has shown that tethering of the nerve in cases with pes planus is an aetiological factor in TTS, and also that, in cadaver studies, stabilisation procedures such as triple arthrodesis and distraction calcaneocuboid arthrodesis are superior to decompression. Trepman [29] has shown that most cases of TTS formerly classified as idiopathic had tethering of the nerve due to the position of the hindfoot.…”

“…Although the number of cases in our series was limited the association between night pain and particular aetiologies of TTS suggests that night pain is not related to foot posture. The volume of the tarsal tunnel changes with differing deformities of the hindfoot and hypermobility of the hindfoot may induce the syndrome because of local tethering of the nerve [1,6,13,24,29]. Heel varus and pronation of the forefoot are also aetiological factors [21].…”