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

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.

Distal Leg Posterior Tibial Nerve Schwannomas Combined With Tarsal Tunnel Syndrome: A Case Series and Literature Review

While the pathophysiology of space-occupying lesions inside the tarsal tunnel causing tarsal tunnel syndrome (TTS) is obvious, the occurrence of a posterior tibial nerve (PTN) mass outside the tarsal tunnel but mimicking or in combination with TTS symptomatology is less clear. Therefore, we report three rare cases of patients presenting with TTS symptoms combined with a distal leg PTN schwannoma, all of whom were treated with tumor resection and tarsal tunnel decompression. All patients had a long-lasting history of leg and ankle pain radiating to the medial aspect of the foot and toes. Pain was especially worsened at night, during walking, and with weight bearing. PTN schwannomas were located at the distal third of the leg. One patient was secondarily decompressed after previous tumor resection elsewhere. The surgical approach included tumor resection with fascicle-sparing enucleation and tarsal tunnel decompression with single or two incisions. Tumor resection was complete in all patients, and the diagnosis of schwannomas was confirmed by histological analysis. Transient-sensitive deterioration was documented in one patient, but there were no motor complications. The pain was resolved completely in two patients and partially in one patient at the last follow-up. PTN schwannomas mimicking or in combination with TTS make the diagnosis challenging since they share most of the clinical symptoms and signs. Such recognition is of utmost importance for better patient management. In these situations, tarsal tunnel decompression could be included in the surgical procedure to achieve long-lasting relief of pain.

Postoperative Outcomes Between Positive and Negative Electrodiagnosis in Patients With Tarsal Tunnel Syndrome: A Retrospective Comparative Study

BACKGROUND

The sensitivity of diagnosing tarsal tunnel syndrome with an electrodiagnostic study is just over 50%. Given this low reliability, many surgeons prefer to make a diagnosis solely from a physical examination, despite reported electrodiagnostic findings. Thus, to understand the clinical ramifications between these 2 methods of diagnosis, this investigation compared the postoperative outcomes following a tarsal tunnel release between patients with positive and negative preoperative electrodiagnosis (EDx).

METHODS

This study retrospectively reviewed 53 consecutive patients who underwent tarsal tunnel release by a single surgeon between 2015 and 2022. The primary outcome was pain level using visual analog scale (VAS) whereas the secondary outcomes were 36-Item Short Form Health Survey questionnaire, Foot and Ankle Ability Measure, recovery times (time to return to activities of daily living, work, and sports), and complications. Pre- and postoperative functional outcomes were compared within each EDx group using a paired sample t test. Postoperative outcomes between groups were compared using a generalized linear model adjusted for potential confounders.

RESULTS

Both EDx groups (positive studies = 31 patients and negative studies = 22 patients) demonstrated significant improvement of all functional outcomes (P < .001). We found no significant difference in recovery time or postoperative outcomes between the 2 groups (P > .05). Multivariable analysis showed diabetes (risk ratio [RR] = 1.79, 95% CI 1.11-2.90) and longer duration of symptoms before surgery (RR = 1.02, 95% CI 1.00-1.04) as prognostic factors for residual pain following tarsal tunnel release.

CONCLUSION

In our series, we found that preoperative electrodiagnostic results did not prognosticate postoperative functional outcomes or recovery times after tarsal tunnel release.