TARSAL TUNNEL-SYNDROME - DIAGNOSIS, SURGICAL TECHNIQUE, AND FUNCTIONAL OUTCOME

During a 10-year period, 47 patients underwent surgical management for tarsal tunnel syndrome (TTS). Of these, 34 (36 feet) were available f ar complete retrospective analysis by record review, questionnaire, an d physical examination, An additional 10 patients were evaluated by re cord review alone, The mean age was 38 years (range, 12-65 years), Ove rall, average follow-up was 35 months (range, 15-102 months). All pati ents had nonsurgical care for an average of 16 months before surgery ( range, 1-72 months), The symptom triad of pain, paresthesias, and numb ness was the most common clinical presentation, All had a positive Tin el's sign and nerve compression test (NCT) at the tarsal tunnel, Elect rodiagnostic studies were abnormal in 38 feet (81%). Two-point discrim ination was diminished significantly by an average of 6.7 mm, At a fol low-hip examination two-point discrimination improved by an average of 3.8 mm (P < 0.001), Eighteen feet continued to have a positive Tinel' s sign and had a residual NCT, Subjectively, patients were satisfied w ith the surgical outcome in 72% of the cases, Postoperative improvemen t in the median Symptom Severity Scare and the Functional Foot Score r eflected this satisfaction, The perioperative complication rate was 30 %, We conclude that the diagnosis of TTS is made primarily on history and clinical evaluation with electrodiagnostic studies supporting the diagnosis in 81%, Surgical treatment is warranted after nonsurgical ma nagement has failed. Division of the deep portions of the abductor hal lucis fascia is Important to ensure a complete release.