1
|
Duarte ML, da Silva MO, Soares ODSR. Tortuosity and Pulsatility of the Tibial Artery - Two Case Reports of a Rare Etiology of Tarsal Tunnel Syndrome. ACTA MEDICA (HRADEC KRALOVE) 2023; 66:161-164. [PMID: 38588395 DOI: 10.14712/18059694.2024.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
Abstract
Tarsal tunnel syndrome is a neuropathic compression of the tibial nerve and its branches on the medial side of the ankle. It is a challenging diagnosis that constitutes symptoms arising from damage to the posterior tibial nerve or its branches as they proceed through the tarsal tunnel below the flexor retinaculum in the medial ankle, easily forgotten and underdiagnosed. Neural compression by vascular structures has been suggested as a possible etiology in some clinical conditions. Tibial artery tortuosity is not that rare, but only that it affects the nerve can cause tarsal tunnel syndrome. Therefore, a study care must be taken to avoid false-positive errors.
Collapse
Affiliation(s)
- Márcio Luís Duarte
- Radiology professor at Universidade de Ribeirão Preto Campus Guarujá, Guarujá-SP, Brazil.
| | | | | |
Collapse
|
2
|
Fantino O, Bouysset M, Pialat JB. Can the axial cross-sectional area of the tibial nerve be used to diagnose tarsal tunnel syndrome? An ultrasonography study. Orthop Traumatol Surg Res 2021; 107:102630. [PMID: 32682728 DOI: 10.1016/j.otsr.2020.02.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 11/11/2019] [Accepted: 02/20/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION The axial cross-sectional area (CSA) of the tibial nerve can be measured with ultrasonography. In patients who have posteromedial tarsal tunnel syndrome (TTS), there is little information on the nerve's CSA even though this information could be useful for determining whether the nerve is damaged. This led us to carry out a case-control study in which the tibial nerve's axial CSA was measured in healthy patients and in patients with TTS. HYPOTHESIS The tibial nerve's axial CSA can be used as a diagnostic criterion for TTS. METHODS Twenty-three patients (27 feet) (11 men, 12 women, mean age=54±14 years), who had clinical and electroneuromyography signs of TTS, were compared to 21 healthy adults (8 men, 13 women, mean age 39±10 years). An ultrasonography examination was carried out to look for a source of nerve compression, then the axial CSA of the tibial nerve was measured 10cm above the tarsal tunnel (lCSA) and inside the tunnel itself (ttCSA). The difference between the two measurements was then calculated: ΔCSA=ttCSA-lCSA. The data were analysed using correlation tests and non-parametric tests, a multivariate linear regression and ROC tests. RESULTS A compressive cause was found by ultrasonography in 13 patients. The mean values of ttCSA and ΔCSA were 20.1±8.8 mm2 [6-42] vs. 10.3±2.3 mm2 [8-14] (p=0.0001) and 9.8±6.7 mm2 [0-29] vs. -0.2±1.8 mm2 [-3-4] (p<0.0001) in the patients and the controls, respectively. The differences in ΔCSA remained significant in the multivariate analysis after adjusting for age and weight. The best threshold for ttCSA in the TTS group was 15 mm2 with 74% sensitivity and 100% specificity. The best threshold for ΔCSA was 5mm2 with 81% sensitivity and 100% specificity. DISCUSSION The difference in the measured axial CSA of the tibial nerve by ultrasonography between the posteromedial tarsal tunnel and 10cm above the tunnel is a key data point for the diagnosis of tarsal tunnel syndrome with and without compressive etiology. LEVEL OF EVIDENCE III, diagnostic case-control study.
Collapse
Affiliation(s)
- Olivier Fantino
- Imagerie Médicale du Parc, Clinique du Parc, 155 bis, boulevard Stalingrad, 69006 Lyon, France; Service de Radiologie, Groupement Hospitalier Sud, 165, chemin du Grand-Revoyet, 69310 Pierre Bénite, France.
| | - Maurice Bouysset
- Cabinet de Rhumatologie, 19, cours Lafayette, 69006 Lyon, France
| | - Jean-Baptiste Pialat
- Service de Radiologie, Groupement Hospitalier Sud, 165, chemin du Grand-Revoyet, 69310 Pierre Bénite, France; Université de Lyon, Lyon, France
| |
Collapse
|
3
|
Moroni S, Gibello AF, Zwierzina M, Nieves GC, Montes R, Sañudo J, Vazquez T, Konschake M. Ultrasound-guided decompression surgery of the distal tarsal tunnel: a novel technique for the distal tarsal tunnel syndrome-part III. Surg Radiol Anat 2019; 41:313-321. [PMID: 30798383 PMCID: PMC6420489 DOI: 10.1007/s00276-019-02196-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Accepted: 01/20/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND The aim of this study was to provide a safe ultrasound-guided minimally invasive surgical approach for a distal tarsal tunnel release concerning nerve entrapments. METHODS AND RESULTS The study was carried out on ten fresh-frozen feet. All of them have been examined by high-resolution ultrasound at the distal tarsal tunnel. The surgical approach has been marked throughout the course of the medial intermuscular septum (MIS, the lateral fascia of the abductor hallucis muscle). After the previous steps, nerve decompression was carried out through a MIS release through a 2.5 mm (± 0.5 mm) surgical portal. As a result, an effective release of the MIS has been obtained in all fresh-frozen feet. CONCLUSION The results of our anatomic study indicate that this novel ultrasound-guided minimally invasive surgical approach for the release of the MIS might be an effective, safe and quick decompression technique treating selected patients with a distal tarsal tunnel syndrome.
Collapse
Affiliation(s)
- Simone Moroni
- Department of Podiatry, Faculty of Health Sciences at Manresa, Universitat de Vic-Universitat Central de Catalunya (UVic-Ucc), Barcelona, Spain.,Clinic Vitruvio Biomecánica, Madrid, Spain
| | - Alejandro Fernández Gibello
- Clinic Vitruvio Biomecánica, Madrid, Spain.,Department of Podiatry, Faculty of Health Sciences, University of La Salle, Madrid, Spain
| | - Marit Zwierzina
- Department of Plastic, Reconstructive and Aesthetic Surgery, Center of Operative Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Gabriel Camunas Nieves
- Clinic Vitruvio Biomecánica, Madrid, Spain.,Department of Podiatry, Faculty of Health Sciences, University of La Salle, Madrid, Spain
| | - Rubén Montes
- Clinic Vitruvio Biomecánica, Madrid, Spain.,Department of Podiatry, Faculty of Health Sciences, University of La Salle, Madrid, Spain
| | - José Sañudo
- Anatomy and Embryology Department, School of Medicine, Complutense University of Madrid, Madrid, Spain
| | - Teresa Vazquez
- Anatomy and Embryology Department, School of Medicine, Complutense University of Madrid, Madrid, Spain
| | - Marko Konschake
- Division of Clinical and Functional Anatomy, Department of Anatomy, Histology and Embryology, Medical University of Innsbruck (MUI), Müllerstr. 59, 6020, Innsbruck, Austria.
| |
Collapse
|
4
|
Fernández-Gibello A, Moroni S, Camuñas G, Montes R, Zwierzina M, Tasch C, Starke V, Sañudo J, Vazquez T, Konschake M. Ultrasound-guided decompression surgery of the tarsal tunnel: a novel technique for the proximal tarsal tunnel syndrome-Part II. Surg Radiol Anat 2018; 41:43-51. [PMID: 30382330 PMCID: PMC6513797 DOI: 10.1007/s00276-018-2127-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 10/24/2018] [Indexed: 11/27/2022]
Abstract
Background The aim of this study is to provide a safe ultrasound-guided minimally invasive surgical approach for a proximal tarsal tunnel release concerning nerve entrapments. Methods and results The study was carried out on ten fresh-frozen feet. All of them were examined by high resolution ultrasound at the medial ankle region. The surgical approach was marked throughout the course of the flexor retinaculum (laciniate ligament). Once the previous steps were done, the flexor retinaculum release technique was carried out with a 2-mm entry only. As a result, an effective and safe release of the flexor retinaculum was obtained in all fresh-frozen feet. Conclusion The results of our anatomic study indicate that our novel ultrasound-guided minimally invasive surgical approach for the release of the flexor retinaculum might be an effective, safe and quick decompression technique treating selected patients with a proximal tarsal tunnel syndrome.
Collapse
Affiliation(s)
- Alejandro Fernández-Gibello
- Faculty of Health Sciences, Department of Podiatry, University of La Salle, Clinic Vitruvio Biomecánica, Madrid, Spain
| | - Simone Moroni
- Faculty of Health Sciences at Manresa, Department of Podiatry, Universitat de Vic-Universitat Central de Catalunya (UVic-Ucc), Clinic Vitruvio Biomecánica, Barcelona, Madrid, Spain
| | - Gabriel Camuñas
- Faculty of Health Sciences, Department of Podiatry, University of La Salle, Clinic Vitruvio Biomecánica, Madrid, Spain
| | - Rubén Montes
- Faculty of Health Sciences, Department of Podiatry, University of La Salle, Clinic Vitruvio Biomecánica, Madrid, Spain
| | - Marit Zwierzina
- Department of Plastic, Reconstructive and Aesthetic Surgery, Center of Operative Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Christoph Tasch
- Department of Plastic, Reconstructive and Aesthetic Surgery, Center of Operative Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Vasco Starke
- Department of Anatomy, Histology and Embryology, Division of Clinical and Functional Anatomy, Medical University of Innsbruck (MUI), Müllerstr. 59, 6020, Innsbruck, Austria
| | - José Sañudo
- Anatomy and Embryology Department, School of Medicine, Complutense University of Madrid, Madrid, Spain
| | - Teresa Vazquez
- Anatomy and Embryology Department, School of Medicine, Complutense University of Madrid, Madrid, Spain
| | - Marko Konschake
- Department of Anatomy, Histology and Embryology, Division of Clinical and Functional Anatomy, Medical University of Innsbruck (MUI), Müllerstr. 59, 6020, Innsbruck, Austria.
| |
Collapse
|
5
|
Surgical interventions for entrapment and compression of the tibial and deep peroneal nerves including tarsal tunnel syndrome. Hippokratia 2017. [DOI: 10.1002/14651858.cd010630.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
|
6
|
Tawfik EA, El Zohiery AK, Abouelela AAK. Proposed Sonographic Criteria for the Diagnosis of Idiopathic Tarsal Tunnel Syndrome. Arch Phys Med Rehabil 2015; 97:1093-9. [PMID: 26705883 DOI: 10.1016/j.apmr.2015.11.012] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 08/20/2015] [Accepted: 11/16/2015] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To propose new sonographic criteria for the diagnosis of idiopathic tarsal tunnel syndrome (TTS). DESIGN Prospective case-control study. SETTING Academic referral center. PARTICIPANTS Adult healthy volunteers (n=17) and adult patients (n=14) with electrodiagnostically proven idiopathic TTS (mean age, 43.4±8.7y; height, 161.4±7.0cm; weight, 90.6±13.9kg) (N=31). The exclusion criteria were patients with diabetes, neurological disorders, associated ankle and/or foot disorders, electrodiagnostic evidence of a widespread lesion, or feet that were electrophysiologically negative for TTS or with structural abnormalities detected via ultrasound imaging. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Tibial nerve CSA at the proximal tarsal tunnel, tibial nerve CSA within the tunnel, within tunnel-to-proximal tunnel CSA ratio. RESULTS There was a significant difference in the within tunnel CSA and within tunnel-to-proximal tunnel CSA ratio between the TTS group and controls (P=.002 and P=.001, respectively). The optimum cutoff value was 19mm(2) for the within tunnel CSA and 1 for the within tunnel-to-proximal tunnel CSA ratio. Sensitivities were 61% and 74%, respectively. CONCLUSIONS The within tunnel-to-proximal tunnel CSA ratio and the within tunnel CSA are the most accurate sonographic parameters and can be helpful in the assessment of idiopathic TTS.
Collapse
Affiliation(s)
- Eman A Tawfik
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
| | - Abeer K El Zohiery
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Amr A K Abouelela
- Department of Orthopedic Surgery and Traumatology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| |
Collapse
|
7
|
Kerasnoudis A, Tsivgoulis G. Nerve Ultrasound in Peripheral Neuropathies: A Review. J Neuroimaging 2015; 25:528-38. [PMID: 25996962 DOI: 10.1111/jon.12261] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 04/06/2015] [Indexed: 12/12/2022] Open
Abstract
Peripheral neuropathies are one of the most common reasons for seeking neurological care in everyday practice. Electrophysiological studies remain fundamental for the diagnosis and etiological classification of peripheral nerve impairment. The recent technological development though of high resolution ultrasound has allowed the clinician to obtain detailed structural images of peripheral nerves. Nerve ultrasound mainly focuses on the evaluation of the cross sectional area, cross sectional area variability along the anatomical course, echogenity, vascularity and mobility of the peripheral nerves. An increase of the cross sectional area, hypervascularity, disturbed fascicular echostructure and reduced nerve mobility are some of the most common findings of entrapments neuropathies, such as the carpal or cubital tunnel syndrome. Both the cross-sectional area increase and the hypervascularity detected with the Doppler technique seem to correlate significantly with the clinical and electrophysiological severity of the later mononeuropathies. Significantly greater cross sectional area values of the clinically affected cervical nerve root are often detected in cases of cervical radiculopathy. In such cases, the ultrasound findings seem also to correlate significantly with disease duration. On the other hand, multifocal cross sectional area enlargement of cervical roots and/or peripheral nerves is often documented in cases of immune-mediated neuropathies. None of the later pathological ultrasound findings seem to correlate significantly with the electrophysiological parameters or the functional disability. The aim of this review is to provide a timely update on the role of neuromuscular ultrasound in the diagnostic of the most common entrapment and immune-mediated peripheral neuropathies in clinical practice.
Collapse
Affiliation(s)
| | - Georgios Tsivgoulis
- Second Department of Neurology, University of Athens, School of Medicine, "Attikon" University Hospital, Athens, Greece.,International Clinical Research Center, St. Anne's University Hospital in Brno, Brno, Czech Republic
| |
Collapse
|
8
|
Norbury JW, Warren KM, Moore DP. Tarsal Tunnel Syndrome Secondary to Suture Material Within the Tibial Artery. Am J Phys Med Rehabil 2014; 93:361. [DOI: 10.1097/phm.0b013e318282e9a3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
9
|
Role of ultrasound in posteromedial tarsal tunnel syndrome: 81 cases. J Ultrasound 2014; 17:99-112. [PMID: 24883135 DOI: 10.1007/s40477-014-0082-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2014] [Accepted: 01/20/2014] [Indexed: 10/25/2022] Open
Abstract
Posteromedial tarsal tunnel syndrome is a disorder affecting the tibial nerve or its branches. Diagnosis is established on the basis of physical examination and can be confirmed by electrophysiological evidence. However, diagnostic imaging is always required to identify the possible site of compression. High-resolution ultrasound (US) is playing an increasingly important role in the study of the nerves thanks to a series of advantages over magnetic resonance imaging, such as lower costs and widespread availability, high spatial resolution, fast examination using axial scans, dynamic and comparative studies, possibility of carrying out a study with the patient in the standing position, US Tinel sign finding, and the contribution of color/power Doppler US. We present the results obtained in a series of 81 patients who underwent US imaging between 2008 and 2013 due to posteromedial tarsal tunnel syndrome.
Collapse
|