Anatomical bases of endoscopic tarsal tunnel release: anatomical and ultra-sonographic study with a preliminary clinical report.
OBJECTIVE
The purpose of our study is to present the anatomical bases of a new technique for endoscopic tarsal release and to report the preliminary clinical outcome for this technique.


METHODS
Anatomical study The technique was performed on 12 intact adult lower limb specimens. The location of portals was evaluated as well as the integrity of the neurovascular bundle. Ultra-sonographic study A prospective case control study was done on 10 patients (11 feet) and 14 normal volunteers (28 feet). Three parameters were measured; the thickness of flexor retinaculum, the nerve cross-section area and the depth of tarsal tunnel. Clinical study Seven patients with idiopathic proximal Tarsal Tunnel Syndrome (TTS) were treated by endoscopic TTR using a modified trocar cannula and dilator system. Preoperative and postoperative evaluation was done by electrophysiological studies and ultra-sonography. Evaluation was done using Takakura's rating scale.


RESULTS
Anatomical study The proximal and distal portals were located at 13 mm (±1.59 STD) and 17.91 mm (±1.44 STD) from the proximal and distal borders of FR, respectively. There was intact neurovascular bundle in all specimens. Ultra-sonographic study There was statistically significant difference in the mean nerve cross-sectional area and the thickness of the FR between the control group and the patients group (P < 0.05). Clinical study The mean TRS improved from 2.28 ± 1.11 STD preoperatively to 8.43 ± 0.97 at 2 years follow-up. The overall good to excellent results was 85.7%.


CONCLUSIONS
Based on this preliminary clinical study, endoscopic tarsal tunnel release by the technique described could obtain excellent to good results in 85.7% of patients with idiopathic proximal tarsal tunnel. The anatomical study proved the safety of the technique on the neurovascular structures. Ultra-sonography was an effective tool for preoperative diagnosis and postoperative follow-up.


METHODS
Case series study, Level IV.
Orthopedic Department, Ain Shams University, Cairo, Egypt. ossama_elshazly@yahoo.com
Ossama
O
El Shazly
Ayman
A
El Shazly
Ahmed
A
Desouky
Abeer Kadry
AK
El Zohiery
Hossam Moussa
HM
Sakr
D000328:Adult; D000368:Aged; D000842:Ankle / Q000033:anatomy & histology / Q000000981:diagnostic imaging / Q000601:surgery*; D016022:Case-Control Studies; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013641:Tarsal Tunnel Syndrome / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome; D014463:Ultrasonography