Tarsal Tunnel Surgery

Before considering tarsal tunnel surgery, consider a few things. Read on to learn more about the Indications, Procedures, Results, and Recovery. Then, contact a physician with experience in treating this condition to find out whether it's right for you. There are several benefits to this type of surgery, including relief of pain and improved function. Your doctor will recommend physical therapy and other treatment options depending on the severity of your condition.

Indications

There are numerous indications of tarsal tunnel syndrome, including poorly fitting shoes, trauma, and anatomic-biomechanical abnormalities. Other causes include systemic conditions like diabetes or arthritis. Sometimes, the condition may be a result of foot shape, causing compression of the tibial nerve. The following list of signs and symptoms of tarsal tunnel syndrome may help guide your decision. If you suspect that you may be suffering from this condition, consult a foot and ankle surgeon.

A positive history and electrodiagnostic results are also useful for determining whether you need tarsal tunnel surgery. Patients with a high probability of nerve compression can achieve a successful clinical outcome with surgical decompression. If electrodiagnostic testing is negative, surgery is not necessary but may be recommended to relieve pain and inflammation. After surgery, the affected ankle will heal within two weeks. Although the procedure is highly successful, there are risks of nerve injury or wound infection. The recovery from tarsal tunnel surgery may be incomplete, and recurrence can occur.

People with tarsal tunnel syndrome often suffer from numbness and pain in their ankles and feet. A condition called tarsal tunnel syndrome occurs when a nerve runs through this area and gets compressed, causing pain or numbness in the first three toes. Patients with severe symptoms may even lose feeling in their feet, making standing and walking difficult. This condition can also lead to muscle weakness and complete loss of sensation.

If you are experiencing pain, inflammation, or other symptoms of TTS, you may need to undergo tarsal tunnel surgery. This procedure is performed to relieve the pressure on the tibial nerve, which runs through the tarsal tunnel. If the tibial nerve is compressed and irritated, a surgical treatment may be necessary to relieve the pain and restore function. Tarsal tunnel syndrome can be treated successfully if diagnosed early.

Procedures

When an ankle pain or injury occurs in the tarsal tunnel, a doctor may perform tarsal tunnel surgery to relieve the symptoms. This procedure creates an opening in the back of the ankle, extending down the arch of the foot. Several types of surgeries are available for this condition, including open surgery and minimally invasive procedures. The early treatment of tarsal tunnel syndrome is crucial for preventing permanent nerve damage.

The procedure generally takes about an hour to perform and may be done under general anesthesia. The area will be wrapped in a soft, bulky bandage for a couple of weeks, so patients should not drive until the bandages are removed. After the surgery, patients will need to use crutches or a walker for a couple of weeks. Patients will also need to limit their weight for the first week, and it is important to use crutches or a walking boot until they are able to move freely without pain.

Following diagnosis, patients may undergo diagnostic nerve blocks or electrical testing to determine if they have tarsal tunnel syndrome. MRI may also be done to rule out a pinched nerve in the lower back. Conservative treatments may include physical therapy, orthotic therapy, and steroid injections. Surgery is generally recommended only if conservative treatment has failed to relieve symptoms. If the symptomatic medications and physical therapy do not work, tarsal tunnel surgery may be the right choice.

In most cases, a temporary cure is necessary to ease symptoms and prevent further nerve damage. If conservative measures fail, steroid injections and custom-made orthotic devices may be recommended. In some cases, however, conservative measures may be necessary, and a long-term solution may be required. In more severe cases, a tarsal tunnel release surgery may be performed. This involves making an incision from the ankle down the foot arch.

An additional type of tarsal tunnel surgery is the insertion of a fat graft. In the past, this procedure was complicated by postoperative wound dehiscence. Today, most surgeons are using less-invasive surgical techniques. Incisions less than an inch long are usually sufficient for this procedure. The patients can walk after the surgery, and they can wear special shoes. Afterward, they can also wear a soft bandage on their foot.

Results

Ultrasound-guided tarsal tunnel surgery is an option for patients with tarsal tunnel syndrome. This procedure involves releasing the tibial nerve, including the distal medial and lateral branches, and the deep fascia of the abductor hallucis muscle. The procedure is performed on an outpatient basis. Patients do not need a tourniquet or general anesthesia.

Postoperative MFS and AOFAS scores were both 80/100. Results were significantly better among patients with symptoms lasting less than one year. The MFS and AOFAS scores were also significantly higher than those who had symptoms for more than a year. In general, local anesthesia is preferred, but sedation is possible for patients. Local anesthesia is less painful for patients, allowing them to alert the surgeon to any radiating pain.

Incision placement is crucial for tarsal tunnel decompression surgery. It is important to locate an incision that allows access to the four distinct nerves in the tarsal tunnel: the lateral, medial, and calcaneal nerves. The surgeon should carefully place an incision at the level of the medial plantar nerve. During the procedure, the nerve is positioned so that it can be released.

Surgical treatment is recommended only after determining whether the diagnosis is correct and tolerable. It may be beneficial or detrimental depending on several factors. Clinical data can be categorized into three categories: preoperative considerations, intraoperative surgical technique, and postoperative care. Preoperative considerations include the diagnosis, duration of symptoms, use of nonsteroidal drugs, and workman's compensation involvement. Preoperative EMG and anesthesia tests were performed in all cases. Postoperative follow-up included VAS scores and modified AOFAS scores.

Postoperative outcomes were largely predictable and high for patients treated by tarsal tunnel neurolysis. However, proper training, a strong attention to detail, and a surgical team with extensive experience are required to perform the procedure. The surgical technique used for tarsal tunnel neurolysis is extremely complicated and demands strong attention to detail. Moreover, postoperative pain and amputation are two of the most complex surgical procedures for tarsal tunnel decompression.

Recovery

If you have tarsal tunnel syndrome, recovery from surgery begins with rest and proper shoe support. Conservative treatment may also include using nonsteroidal anti-inflammatory drugs and changing your diet if you are overweight. Tarsal tunnel surgery involves releasing the structures pressing on the nerve and providing it with a space to heal. If conservative treatment fails to relieve symptoms, surgery may be the best option. Dr. Soomekh has been perfecting and reinventing this surgery for patients suffering from tarsal tunnel syndrome.

The first step to recovery after surgery is to avoid strenuous activity, which may prolong recovery. Physical therapy can help you regain strength and flexibility. Alternatively, surgery may be performed to release the pressure on the nerve. Generally, patients recover well after surgery. Some may require a surgical shoe or orthotic until the bandages have been removed. This procedure is typically performed under general anesthesia and is usually performed in an outpatient setting.

Postoperative complications of tarsal tunnel surgery include impaired wound healing, keloid formation, and infection. Although rare, complex regional pain syndrome has been reported after surgery. Causing pain in the heel region, lesions of the calcaneal branches are associated with increased sensitivity and decreased sensitivity to pain. Recovery from tarsal tunnel surgery is not as fast as that of other surgeries, however.

Physical therapy is another way to speed up recovery from tarsal tunnel surgery. Exercise can help improve your overall physical health and reduce pain. Physiotherapy helps relieve the pain caused by compression of the nerve. It may also be an effective way to eliminate pain associated with the condition. The physical therapy sessions are typically held twice a week for six weeks and are tailored to the needs of each patient. Recovery after tarsal tunnel surgery can be difficult, but it will be worth it once you reach a high level of physical activity.

Physical therapy for tarsal tunnel syndrome is essential for recovery from the surgical procedure. During physical therapy, an ankle sprain may cause swelling, which can further compress the nerve. Additionally, diseases such as diabetes and arthritis can cause the condition. Finally, foot shape can lead to the development of tarsal tunnel syndrome. The pain and swelling typically starts in the heel and spreads to the front of the foot and eventually the big toe.