Surgical Release for Tarsal Tunnel Syndrome

Surgical Release for Tarsal Tunnel Syndrome

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Source: http://nervesurgery.wustl.edu

Tarsal tunnel syndrome describes the compression of the tibial nerve through the tarsal tunnel which results in pain and numbness in the plantar aspect of the foot. The tibial nerve has three major branches which include the calcaneal, medial plantar, and lateral plantar nerve branches. There are two primary structures responsible for compression of the tibial nerve: (1) flexor retinaculum and (2) a septum that compartmentalizes the medial and lateral plantar nerves and the overlying fascia of the abductor hallucis muscle. The tarsal tunnel release involves releasing these structures. In this case, the patient had a traumatic injury to the lower leg, which required open reduction and internal fixation. The patient had pain and numbness in the tibial nerve distribution along with Tinel’s sign and positive scratch collapse at the tarsal tunnel.

Details of Surgical Demonstration:

00:45 Incision / Exposure of Proximal Incision

02:30 Identifying and Dividing the Superficial Fascia through Scar Tissue

03:48 Identification of the Posterior Tibial Vessels

04:48 Identifying and Dividing the Flexor Retinaculum Proximally

06:33 Identification of the Tibial Nerve Proper

07:20 Incision / Exposure of Distal Incision

09:07 Identifying and Incising the Tendinous Fascia Superficial to the Abductor Hallucis

09:46 Retracting the Abductor Hallucis and Identifying the Deep Fascia to the Abductor Hallucis

10:16 Dividing the Deep Fascia Superficial to the Lateral Plantar Nerve

11:30 Identifying the Abductor Hallucis Fascia Superficial to the Medial Plantar Nerve

13:29 Dividing the Abductor Hallucis Fascia Superficial to the Medial Plantar Nerve

14:22 Identification and Release of the Calcaneal Nerve Branch

14:50 Identifying and Dividing the Flexor Retinaculum Distally

15:26 Further Division of the Abductor Hallucis Fascia Superficial to the Lateral Plantar Nerve

Narration: Susan E. Mackinnon

Videography: Andrew Yee