An Update on Posterior Tarsal Tunnel Syndrome

Short term effectevness of tibial nerve flossing technique in patients With tarsal tunnel syndrome

ObjectiveTo examine the short-term influence of adding tibial nerve flossing (TNF) technique to conventional therapy on foot pain, Dorsiflexion-Eversion (DF-E) test, ankle range of motion (ROM), and tibial nerve conduction study (NCS) in individuals with Tarsal Tunnel Syndrome (TTS).MethodsThis was a parallel randomized pre-post-test single blinded controlled trial, included 54 individuals with TTS randomized into study and control groups. Both groups received conventional therapy including transcutaneous electrical nerve stimulation (TENS), therapeutic ultrasound (US), gastrocnemius (GC) muscle stretching, and foot arches supports/wedges provided as needed with an additional (TNF) technique provided for the study group. The intervention was 3 days/week on alternate days, for a four-week duration. Pain severity and DF-E test as primary; ankle dorsiflexion ROM and tibial NCS as secondary measures, were collected pre- and post-treatment.ResultsWithin-groups comparison showed a significant improvement in all tested variables. Post-treatment between-groups comparison showed a notably higher scores in favor for the study group (p < 0.05) except for the (DF-E) test (p > 0.05).ConclusionTibial nerve flossing is an effective adjunct to conventional therapy in improving foot pain, ankle ROM, and tibial nerve conduction in individuals with TTS.

Research Trends and Hotspots Evolution of Nerve Decompression: A Bibliometric Analysis From 2005 to 2024

BACKGROUND

The incidence of nerve entrapment-related diseases, caused by a variety of factors, has been increasing annually, significantly impairing patients' quality of life. Nerve decompression serves as one of the critical approaches for treating such conditions. However, there remains a scarcity of bibliometric analyses within the field of nerve decompression.

METHODS

The publications related to nerve decompression in the Web of Science database from 2005 to 2024 were collected. Bibliometric methods were used to analyze the basic components of publications, synthesize research trends, and predict future research hotspots.

RESULTS

A total of 606 publications were included in our study, with the number of publications ranging from 16 in 2005 to 52 in 2024. In terms of countries, the United States occupies a central position in both the number of publications (213 publications) and the quality (H-index = 34) and works closely with other countries. In terms of publishing institutions, Shanghai Jiao Tong University has the largest number of 18 publications. Acta Neurochirurgica is the journal with the highest number of 27 publications. The focus of research in this field can be divided into 3 main categories: cranial nerves, upper limb nerves, and lower limb nerves. The topic of research has gradually transferred to the lower limb nerve, and the keyword sacral nerve will be a hot topic in this field.

CONCLUSIONS

This is the first bibliometric study to comprehensively summarize trends and hotspots in nerve decompression research. Our findings shed light on future research directions, international collaborations, and interdisciplinary relationships. The sacral nerve has emerged as a current and potential future research hotspot, warranting further exploration.

Overview of nerve entrapment syndromes in the foot and ankle

PURPOSE

Tunnel syndromes around the foot and ankle are underrecognized and frequently misdiagnosed nerve entrapments that can significantly impact patients' quality of life. This review aims to provide a comprehensive overview of the etiology, clinical presentation, diagnostic challenges, and management strategies for these syndromes, focusing on the sural nerve, deep peroneal nerve, tibial nerve, medial plantar nerve, and inferior calcaneal nerve.

METHODS

A thorough literature review was conducted, examining studies and case reports on nerve entrapments in the foot and ankle. The review covers the clinical assessment, differential diagnosis, and treatment options, including conservative and surgical interventions.

RESULTS

Tunnel syndromes of the foot and ankle can arise from various causes, including trauma, anatomical variations, repetitive strain, and systemic conditions. Clinical manifestations often include burning pain, tingling, and motor weakness, depending on the affected nerve. Accurate diagnosis relies on a detailed patient history, physical examination, and adjunctive tests such as electrodiagnostic and imaging. Conservative treatments, such as physical therapy, orthotics, and corticosteroid injections, are often effective, while surgical decompression is reserved for refractory cases.

CONCLUSIONS

Recognizing and diagnosing tunnel syndromes in the foot and ankle is essential for effective management and preventing permanent nerve damage. A systematic approach that integrates clinical evaluation and appropriate imaging can improve patient outcomes. Timely intervention, whether conservative or surgical, is crucial for alleviating symptoms and restoring function.

Rare entrapment neuropathies of the lower extremity: A narrative review

Lower limb entrapment neuropathies comprise a wide range of disorders, including less common conditions like tarsal tunnel syndrome, Morton neuroma, obturator nerve entrapment syndrome, superior gluteal nerve entrapment, and cluneal nerve entrapment syndrome. Despite being less prevalent, these syndromes are equally significant, presenting with symptoms such as pain, dysesthesia, muscular weakness, and distinct physical signs. Accurate diagnosis of these less common disorders is crucial for successful therapy and patient recovery, as they can sometimes be mistaken for lumbar plexopathies, radiculopathies, or musculotendinous diseases. This narrative review highlights the significance of identifying and diagnosing these particular neuropathies through a comprehensive assessment of the patient's medical history, detailed physical examination, and the use of electrodiagnostic and/or ultrasound investigations. When the diagnosis is uncertain, advanced imaging techniques like magnetic resonance neurography or magnetic resonance imaging are necessary to confirm the diagnosis. A positive diagnosis ensures prompt and targeted treatments, preventing further nerve impairments and muscle wasting. This article explores the epidemiology, anatomy, pathophysiology, etiology, clinical presentation, and electrodiagnostic interpretation of lower limb entrapment neuropathies, highlighting the importance of precise diagnosis in achieving favorable patient outcomes.

Diagnostic Approach to Lower Limb Entrapment Neuropathies: A Narrative Literature Review

Entrapment neuropathies of the lower limb are a misunderstood and underdiagnosed group of disorders, characterized by pain and dysesthesia, muscular weakness, and specific provoking movements on physical examination. The most frequent of these syndromes encountered in clinical practice are fibular nerve entrapment, proximal tibial neuropathy, sural nerve neuropathy, deep gluteal syndrome or sciatic nerve entrapment, and lateral femoral cutaneous nerve entrapment, also known as meralgia paresthetica. These are commonly mistaken for lumbar plexopathies, radiculopathies, and musculotendinous diseases, which appear even more frequently and have overlapping clinical presentations. A comprehensive anamnesis, physical examination, and electrodiagnostic studies should help clarify the diagnosis. If the diagnosis is still unclear or a secondary cause of entrapment is suspected, magnetic resonance neurography, MRI, or ultrasonography should be conducted to clarify the etiology, rule out other diseases, and confirm the diagnosis. The aim of this narrative review was to help clinicians gain familiarity with this disease, with an increase in diagnostic confidence, leading to early diagnosis of nerve damage and prevention of muscle atrophy. We reviewed the epidemiology, anatomy, pathophysiology, etiology, clinical presentation, and EDX technique and interpretation of the entrapment neuropathies of the lower limb, using articles published from 1970 to 2022 included in the Pubmed, MEDLINE, Cochrane Library, Google Scholar, EMBASE, Web of Science, and Scopus databases.

Sonographic assessment of the tarsal tunnel compared to cadaveric findings: a pictorial study

Aim of the study

To present the anatomy of the tarsal tunnel and demonstrate the utility of high-resolution ultrasound for tarsal tunnel examination.

Materials and methods

Anatomical dissection was performed on a defrosted cadaveric model to demonstrate relevant anatomical structures of the tarsal tunnel, namely tendons, vessels and nerves. The tibial nerve division was demonstrated; the bifurcation of the tibial nerve into the medial and lateral plantar nerve, two medial calcaneal nerve branches were identified originating from the tibial nerve and the Baxter's nerve was identified as the first branch of the lateral plantar nerve. An ultrasound examination of the tarsal tunnel region was performed on a healthy volunteer. A linear probe was used and sonographic images were obtained at different levels of the tarsal tunnel: the proximal tarsal tunnel, the tibial nerve division into the medial and lateral plantar nerves, the distal tarsal tunnel, the Baxter's nerve branching point and the Baxter's nerve crossing between the abductor hallucis and quadratus plantae muscle.

Results

Sonographic images were correlated with anatomical structures exposed during cadaveric dissection.

Conclusions

We presented the anatomic-sonographic correlation of the tarsal tunnel and showed that high-resolution ultrasound is a useful imaging modality for tarsal tunnel assessment.