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Tun Hing Lui - One of the best experts on this subject based on the ideXlab platform.
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endoscopic ganglionectomy of the Tarsal Tunnel a medial approach
Arthroscopy techniques, 2021Co-Authors: Tun Hing Lui, Sui Kit ChanAbstract:Abstract A ganglion inside the Tarsal Tunnel can compress the tibial nerve, leading to posterior Tarsal Tunnel syndrome. Classically, the ganglion is resected with an open approach. This requires release of the flexor retinaculum and dissection around the tibial neurovascular bundle, which may induce fibrosis around the tibial nerve. Endoscopic resection of a Tarsal Tunnel ganglion via a posterior approach has been reported. The purpose of this Technical Note is to describe the medial approach of endoscopic ganglionectomy of the Tarsal Tunnel. This is indicated for Tarsal Tunnel ganglia compressing the tibial nerve and extending to the flexor retinaculum. It is contraindicated if there is other pathology of the Tarsal Tunnel that demands open surgery; the ganglion compresses the tibial nerve from its deep side and does not extend to the flexor retinaculum; or in the presence of intraneural ganglion of the tibial nerve.
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Endoscopic Resection of the Tarsal Tunnel Ganglion
'Elsevier BV', 2016Co-Authors: Tun Hing LuiAbstract:The Tarsal Tunnel ganglion is a cause of posterior Tarsal Tunnel syndrome. Open resection of the ganglion calls for release of the flexor retinaculum and dissection around the tibial neurovascular bundle. This can induce fibrosis around the tibial nerve. We report the technique of endoscopic resection of the Tarsal Tunnel ganglion. It is indicated for Tarsal Tunnel ganglia arising from the adjacent joints or tendon sheaths and compressing the tibial nerve from its deep side. It is contraindicated if there is other pathology of the Tarsal Tunnel that demands open surgery; if the ganglion compresses the tibial nerve from its superficial side, which calls for a different endoscopic approach using the ganglion portal; or if an intraneural ganglion of the tibial nerve is present. The purpose of this technical note is to describe a minimally invasive approach for endoscopic resection of the Tarsal Tunnel ganglion
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acute posterior Tarsal Tunnel syndrome caused by gouty tophus
Foot and Ankle Specialist, 2015Co-Authors: Tun Hing LuiAbstract:Gouty tophus of the Tarsal Tunnel is a rare cause of posterior Tarsal Tunnel syndrome. We present a case of acute posterior Tarsal Tunnel syndrome due to gouty tophus that required early Tarsal Tunnel release in order to avoid irreversible nerve damage. The presence of background neuropathy resulted in a less favorable result than expected. Levels of evidence Therapeutic, Level V: Case report.
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neurilemmoma of the first branch of the lateral plantar nerve causing Tarsal Tunnel syndrome
Foot and Ankle Specialist, 2009Co-Authors: Ka Bon Kwok, Tun Hing LuiAbstract:In this article, the authors report a case of Tarsal Tunnel syndrome caused by neurilemmoma of the first branch of the lateral plantar nerve, with symptom resolved after excision. A 42-year-old man presented with left medial heel pain radiating to the lateral sole for 6 months. On examination, there was positive Tinel sign over the medial heel with pain radiating to the lateral sole. Ultrasonography and magnetic resonance imaging confirmed the presence of a 1-cm neurogenic tumor inside the Tarsal Tunnel. Intraoperatively, a 1-cm neurilemmoma was found at the first branch of the lateral plantar nerve inside the Tarsal Tunnel. The lesion was excised completely with preservation of its fascicle. The symptom resolved completely after the operation.
Scott J Ellis - One of the best experts on this subject based on the ideXlab platform.
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Effects on the Tarsal Tunnel Following Malerba Z-Type Osteotomy Compared to Standard Lateralizing Calcaneal Osteotomy
SAGE Publishing, 2016Co-Authors: Elizabeth A. Cody, Harry G. Greditzer, Jayme C. Burket, Carolyn M. Sofka, Scott J EllisAbstract:Category: Hindfoot Introduction/Purpose: Tarsal Tunnel syndrome is a known complication of lateralizing calcaneal osteotomy, which is performed to treat cavovarus hindfoot deformities. Lateralizing calcaneal osteotomies have been shown to significantly decrease Tarsal Tunnel volume, which may be a factor in development of Tarsal Tunnel syndrome. A Malerba Z-type osteotomy involves a step cut for lateralization and a lateral wedge resection for rotation. Compared with a standard oblique osteotomy, it may preserve more Tarsal Tunnel volume and decrease risk of neurovascular injury. We investigated two effects on the Tarsal Tunnel of the Malerba osteotomy compared to a standard osteotomy using a cadaveric model: (1) the effect on Tarsal Tunnel volume measured by magnetic resonance imaging (MRI), and (2) the proximity of the osteotomy saw cuts to the tibial nerve. Methods: Five above-knee paired cadaveric specimens underwent MRI of the ankle to obtain a baseline measurement of Tarsal Tunnel volume. Each right foot was randomized to receive either a standard calcaneal osteotomy or a Malerba osteotomy, with the left foot then receiving the other type of osteotomy. MRIs of each specimen were performed after each of three increasing amounts of lateral displacement: 4 mm, 8 mm, and 12 mm. In the Malerba osteotomy group, each displacement was accompanied by increasing amounts of wedge resection: 2 mm, 4 mm, and 6 mm. Tarsal Tunnel volume was measured on oblique coronal images using previously described and validated parameters. Differences in Tarsal Tunnel volume with osteotomy type (Malerba vs. standard), displacement, and their interaction were assessed with generalized estimating equations (GEEs). After all MRIs were completed, each specimen was dissected and the nearest distance of tibial nerve branches to the osteotomy site was measured. Results: Baseline Tarsal Tunnel volume averaged 13,229 ± 2354 mm⁁3 for all specimens, and did not differ between the two study groups (p = 0.386). Tarsal Tunnel volume decreased significantly in all specimens following each translation (p < 0.001 for each), although the magnitude of the decrease did not differ between groups (p = 0.578) (Table). Upon dissection of the specimens, tibial nerve branches crossed the osteotomy site in all specimens (Figure). At least one of the major branches of the tibial nerve crossed the osteotomy site in 5 out of 5 specimens that received the Malerba osteotomy, versus 2 out of 5 that received a standard osteotomy. In the remaining 3 specimens, the lateral plantar nerve was 2 to 8 mm from the osteotomy site. Conclusion: Tarsal Tunnel volume decreased significantly with increasing lateral displacement of a calcaneal osteotomy, regardless of osteotomy type. There was no difference between standard and Malerba osteotomies in terms of volume decrease. However, in the clinical setting, a smaller amount of displacement may be required with a Malerba osteotomy given that some correction is also achieved by a wedge resection for rotation. In all specimens, the osteotomy was at the level of branches of the tibial nerve, showing that calcaneal osteotomies must always be performed with care to avoid direct nerve injury on the unvisualized medial side of the cut
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a case of acute Tarsal Tunnel syndrome following lateralizing calcaneal osteotomy
Foot and Ankle Surgery, 2015Co-Authors: Raymond J Walls, Jeremy Y Chan, Scott J EllisAbstract:Surgical correction of hindfoot varus is frequently performed with a lateral displacement calcaneal osteotomy. It has rarely been associated with iatrogenic Tarsal Tunnel syndrome in patients with pre-existing neurological disease. We report the first case of acute postoperative Tarsal Tunnel syndrome in a neurologically intact patient with post-traumatic hindfoot varus. Early diagnosis and emergent operative release afforded an excellent clinical outcome. Imaging studies can help outrule a compressive hematoma and assess for possible nerve transection; however it is paramount that a high index of suspicion is utilized with judicious operative intervention to minimize long-term sequelae.
Konrad Scheglmann - One of the best experts on this subject based on the ideXlab platform.
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posterior Tarsal Tunnel syndrome diagnosis and treatment
Deutsches Arzteblatt International, 2008Co-Authors: Gregor Antoniadis, Konrad ScheglmannAbstract:Carpal and cubital Tunnel syndromes are among the more common peripheral nerve compression syndromes. Posterior Tarsal Tunnel syndrome is relatively uncommon, though the literature contains no precise estimate of its prevalence. In our experience, it is diagnosed too often. Posterior Tarsal Tunnel syndrome involves damage to the tibial nerve where it lies under the flexor retinaculum (laciniate ligament) on the medial side of the ankle. It is to be distinguished from anterior Tarsal syndrome, in which the deep peroneal nerve is compressed under the extensor retinaculum on the dorsum of the foot. Pollock and Davis described posttraumatic compression of the tibial nerve as early as 1933 (1). In 1960, Kopell and Thompson described the clinical manifestations of Tarsal Tunnel syndrome (2). Keck coined the expression "Tarsal Tunnel syndrome" in his case report of 1962 (3). Keck thought that the condition was underdiagnosed and frequently misdiagnosed as plantar fasciitis. Keck and Lam independently recommended considering this type of compression syndrome in the differential diagnosis whenever a patient complains of pain and paresthesia in the sole of the foot (3, 4). In this article, we will present the current state of the diagnostic assessment of posterior Tarsal Tunnel syndrome and its treatment on the basis of a selective review of the literature and our own extensive experience.
Byron Shields - One of the best experts on this subject based on the ideXlab platform.
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a touch pressure sensory assessment of the surgical treatment of the Tarsal Tunnel syndrome
Foot and Ankle Surgery, 2011Co-Authors: William H Gondring, Byron ShieldsAbstract:Abstract Background Decompressive Tarsal Tunnel surgery may improve dysfunctional plantar foot sensation in, patients with Tarsal Tunnel syndrome and peripheral neuropathy. However, quantitative sensory, assessment is lacking. Method Quantitative sensory threshold evaluation of 42 feet in 37 consecutive (29 non-diabetic and 8 diabetic) patients was done before and after surgical decompression for Tarsal Tunnel syndrome. Insensitivity was documented quantitatively (grams force) before and after surgery using a graded series of twenty Semmes–Weinstein monofilaments applied to the anatomic nerve regions of the plantar aspect of the foot. Results Sensory evaluation at an average of 12 months after surgery showed significant improvement, of mean sensory threshold, compared with preoperative values, for medial calcaneal, medial plantar, and lateral plantar nerves. Conclusion Quantitative sensory assessment with a graded series of twenty Semmes–Weinstein, monofilaments showed significant sensory improvement in the medial calcaneal, medial plantar, and, lateral plantar nerves after posterior tibial nerve decompression.
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Tarsal Tunnel syndrome assessment of treatment outcome with an anatomic pain intensity scale
Foot and Ankle Surgery, 2009Co-Authors: William H Gondring, Elly Trepman, Byron ShieldsAbstract:Abstract Background Assessment of treatment outcomes for Tarsal Tunnel syndrome may be improved with a standardized pain rating scale using a descriptive anatomical foot model for pretreatment and post-treatment plantar foot pain analysis. Methods Prospective evaluation of 46 consecutive patients (56 feet) who had non-operative and surgical treatment for Tarsal Tunnel syndrome. Pain intensity was documented before and after treatment with the Wong-Baker FACES Pain Rating Scale applied to the anatomic nerve regions of the plantar aspect of the foot. Results In patients who had successful non-operative treatment, overall pain intensity was significantly improved in the medial calcaneal, medial plantar, and lateral plantar nerve regions. In patients who had ongoing symptoms despite non-operative treatment, surgical treatment resulted in significant pain improvement in the medial calcaneal and medial plantar, but not lateral plantar, nerve regions. Pretreatment motor nerve conduction latency was significantly greater in patients who had surgical treatment than those who had only non-operative treatment. Conclusions Anatomic pain intensity rating models may be useful in the pretreatment and follow-up evaluation of Tarsal Tunnel syndrome. Predictors of failed non-operative treatment included longer motor nerve conduction latency and greater predominance of foot comorbidities.
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an outcomes analysis of surgical treatment of Tarsal Tunnel syndrome
Foot & Ankle International, 2003Co-Authors: William H Gondring, Byron Shields, Steve WengerAbstract:Sixty patients (68 feet) underwent Tarsal Tunnel release for the Tarsal Tunnel syndrome and were re-examined objectively and clinically after they had reached maximum medical benefits and returned to their usual and customary lifestyle and employment. All of the patients demonstrated both a positive tinel sign and an abnormal motor nerve conduction velocity measurement. As determined objectively, there was 85% complete symptom relief. As determined subjectively, there was 51% symptom relief. Additionally, there was significant improvement in the quality of work, job productivity, and interpersonal relationships. There was a clinical dichotomy, however, between the objective pain relief measurement in contrast to the subjective patient's assessment.
Raymond J Walls - One of the best experts on this subject based on the ideXlab platform.
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a case of acute Tarsal Tunnel syndrome following lateralizing calcaneal osteotomy
Foot and Ankle Surgery, 2015Co-Authors: Raymond J Walls, Jeremy Y Chan, Scott J EllisAbstract:Surgical correction of hindfoot varus is frequently performed with a lateral displacement calcaneal osteotomy. It has rarely been associated with iatrogenic Tarsal Tunnel syndrome in patients with pre-existing neurological disease. We report the first case of acute postoperative Tarsal Tunnel syndrome in a neurologically intact patient with post-traumatic hindfoot varus. Early diagnosis and emergent operative release afforded an excellent clinical outcome. Imaging studies can help outrule a compressive hematoma and assess for possible nerve transection; however it is paramount that a high index of suspicion is utilized with judicious operative intervention to minimize long-term sequelae.
