The natural history of tarsal tunnel syndrome in diabetic subjects

Abstract

Introduction: Tibial nerve entrapment is highly prevalent in diabetic subjects, resulting in significantly more neuropathic complaints and concomitant sensory disturbances. The study aim was to assess the impact of tarsal tunnel syndrome (TTS) and sensory loss at baseline on incident diabetic foot ulceration (DFU) in diabetic patients, since decompressing the tibial nerve might change the natural history of the disease. Methods: In this study, 113 subjects with TTS (69 bilateral, 23 left-sided and 21 right-sided) participating in the prospective Rotterdam Diabetic Foot Study were compared to 303 diabetic controls without TTS, regarding incident DFU. Kaplan-Meier analysis and Cox's regression analysis were used to determine the independent hazard of baseline variables for new DFU. Results: The median observation period was 836.5 days (IQR, 459-1077.8). In bilateral TTS, 17.4% (95% CI: 8.4-26.3%) of subjects experienced DFU versus 8.3% (95% CI: 5.1-11.6%) in controls (left or right) during follow-up (p = 0.0036). In left-sided TTS, no subjects versus 6.2% (95% CI: 3.4-9.0%) in controls had DFUs (p = 0.243). Incident ulceration was seen in 14.3% (95% CI: −0.7% to −29.3%) of right-sided TTS subjects versus 4.1% (95% CI: 1.5-6.3%) in controls (p = 0.034). Besides HbA1c, diminished sensation at the hallux independently increased the Dates and sites of presentation:

Clinical Results Following Conservative Management of Tarsal Tunnel Syndrome Compared With Surgical Treatment: A Systematic Review

“…Identified medical conditions include hypothyroidism, diabetes mellitus, systemic sclerosis, chronic renal failure. 4,7,[15][16][17][18][19][20][21] The myxedema that occurs in hypothyroidism can lead to tarsal tunnel syndrome from the increased swelling of tissues in the tarsal tunnel. 17 Patients affected by diabetes mellitus have higher rates of tarsal tunnel syndrome due to the chronic compression of the posterior tibial nerve which can further lead to diabetic foot ulceration.…”

“…17 Patients affected by diabetes mellitus have higher rates of tarsal tunnel syndrome due to the chronic compression of the posterior tibial nerve which can further lead to diabetic foot ulceration. 18,19 Hemodialysis patients were found to have tarsal tunnel syndrome with rates up to 0.5% with increasing prevalence as maintenance dialysis went beyond 5 years most likely due to the deposition of beta-2 microglobulin. 21…”

Does Lower Extremity Nerve Decompression Surgery Improve Quality of Life?

“…[18][19][20] The test grades the level of somatosensory function in the distal lower extremity and relates to postural stability, risk of falls, risk of ulceration, and surgical outcome of LEND surgery. 18,[21][22][23] The Tinel sign was used for the diagnosis of lower extremity peripheral nerve entrapment. 24 Lower extremity artery pulsations were palpated.…”

Tarsal tunnel syndrome: current rationale, indications and results

“…They evaluated the impact of TTS and initial sensory loss on DFU, given tibial nerve decompression could change the natural history of the disease (preventing diabetic foot disease and thus reducing the risk of amputation). 59 It was observed that bilaterally affected patients have a poorer evolution compared to unilateral patients and controls, and they have a higher risk of developing DFU than unilateral patients. Thus, it appears that surgical decompression of the tarsal tunnel in diabetic patients with TTS might decrease the risk of developing DFU.…”