Surgical Release for Tarsal Tunnel Syndrome

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