Expert Insights On Peripheral Nerve Surgery For Tarsal Tunnel Syndrome

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This is the proper way to separate tissues, ensuring that neural structures are not damaged in accessing the tarsal tunnel.
Proper incision planning is essential in tarsal tunnel surgery. By ending the distal aspect of the incision over the lateral plantar nerve tunnel, you can ensure access to all of the tunnels for adequate decompression/neurolysis.
Here you can see a misplaced incision, which led to inadequate access to the medial calcaneal tunnel and lateral plantar nerve tunnel, and resulted in a recurrent tarsal tunnel syndrome.
Once you have achieved adequate neurolysis/decompression, you should be able to pass your index finger easily into the plantar aspect of the arch of the foot. If you cannot do this, the decompression is not complete.
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Author(s): 
By Stephen L. Barrett, DPM

Apply this bulky Jones-type compression dressing in such a manner that there is no real direct compression on the extremity. We do not want to compress something we just spent meticulous time in decompressing. However, you would apply a compressive wrap for 30 minutes after deflating the tourniquet and then remove the wrap.
Emphasize partial weightbearing for three weeks with a gradual increase in pressure and activity during this time. Remove sutures or staples at three weeks. These patients usually are fully active between three and five weeks, and should be informed that they can expect the swelling to dissipate over the next three to four months.

In Conclusion
Surgical intervention for lower extremity peripheral nerve pathology can be positively life-changing for the patient. However, a lack of adherence to sound surgical procedures, indelicate tissue handling and a lack of surgical experience with regard to nerve tissues could lead to disastrous consequences for the patient.

Dr. Burks is a Fellow of the American College of Foot and Ankle Surgeons and is board-certified in foot and ankle surgery. Dr. Burks practices in Little Rock, Ark.




References:

References
1. Keck C: The tarsal tunnel syndrome, J Bone Joint Surg, 44A:180, 1962.
2. Mackinnon SE, Dellon AL: Surgery of the peripheral nerve, Thieme, N.Y., 1988.
3. Dellon AL: Somatosensory testing and rehabilitation, Institute for Peripheral Nerve Surgery, Baltimore, 2000.
4. Tassler PL, Dellon AL: Pressure perception in the normal lower extremity and in tarsal tunnel syndrome. Muscle Nerve 19:285-289, 1996.
5. Weber RA, Schuchmann JA, Albers JH, Ortiz J: Prospective blinded evaluation of nerve conduction velocity versus pressure-specified sensory testing in carpal tunnel syndrome. Plastic and Reconstructive Surgery 436(3):252-257, 2000.
6. Mackinnon SE, Dellon AL: Homologies between the tarsal and carpal tunnels: Implications for treatment of the tarsal tunnel syndrome. Contemp Orthop 14:75-79, 1987
7. Dellon AL, Kim J, Spaulding CM: Variations in the origin of the medial calcaneal nerve. JAPMA, Vol. 92, #2, 2002.

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