TY - JOUR
T1 - The Four Medial Ankle Tunnels
T2 - A Critical Review of Perceptions of Tarsal Tunnel Syndrome and Neuropathy
AU - Dellon, A. Lee
N1 - Copyright:
Copyright 2009 Elsevier B.V., All rights reserved.
PY - 2008/10
Y1 - 2008/10
N2 - The mechanisms of symptom production (other than a space-occupying lesion) and the diagnosis of tarsal tunnel syndrome remain controversial. To understand the diagnosis and treatment of tarsal tunnel syndrome in the presence of neuropathy, the known anatomy and pathophysiology related to the tarsal tunnel and the existing basic science and clinical evidence base related to these topics are reviewed. It is concluded that it is difficult to identify patients with tibial nerve compression at the ankle or foot region reliably with traditional electrodiagnostic techniques, even in the absence of neuropathy, and that the presence of a positive "Tinel" sign over the tibial nerve in the tarsal tunnel can identify this as a site of chronic nerve compression. For patients with tarsal tunnel syndrome and the comorbidity of diabetic polyneuropathy (DPN), it is concluded that a positive Tinel sign at the tarsal tunnel can predict a positive outcome for pain relief and restoration of sensation in 80% of the people who have decompression of the four medial ankle tunnels. With sensation improved, it is concluded that the natural history of DPN can be changed toward prevention of ulcers and amputation.
AB - The mechanisms of symptom production (other than a space-occupying lesion) and the diagnosis of tarsal tunnel syndrome remain controversial. To understand the diagnosis and treatment of tarsal tunnel syndrome in the presence of neuropathy, the known anatomy and pathophysiology related to the tarsal tunnel and the existing basic science and clinical evidence base related to these topics are reviewed. It is concluded that it is difficult to identify patients with tibial nerve compression at the ankle or foot region reliably with traditional electrodiagnostic techniques, even in the absence of neuropathy, and that the presence of a positive "Tinel" sign over the tibial nerve in the tarsal tunnel can identify this as a site of chronic nerve compression. For patients with tarsal tunnel syndrome and the comorbidity of diabetic polyneuropathy (DPN), it is concluded that a positive Tinel sign at the tarsal tunnel can predict a positive outcome for pain relief and restoration of sensation in 80% of the people who have decompression of the four medial ankle tunnels. With sensation improved, it is concluded that the natural history of DPN can be changed toward prevention of ulcers and amputation.
KW - Tarsal tunnel • Neuropathy • Diabetes • Decompression
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U2 - 10.1016/j.nec.2008.07.003
DO - 10.1016/j.nec.2008.07.003
M3 - Review article
C2 - 19010287
AN - SCOPUS:55849102545
VL - 19
SP - 629
EP - 648
JO - Neurosurgery Clinics of North America
JF - Neurosurgery Clinics of North America
SN - 1042-3680
IS - 4
ER -