title: Tarsal tunnel syndrome in hemodialysis patients: a case series.
abstract: BACKGROUND
  The purpose of our study was to investigate tarsal tunnel syndrome (TTS) arising in patients who have undergone maintenance dialysis at our facility and to evaluate the frequency, pathological characteristics, and diagnosis of TTS.
  
  
  METHODS
  We evaluated 1011 patients (mean age 65.1 years) undergoing maintenance dialysis from 2000 to 2006 at our hospital. In patients diagnosed with TTS, we examined clinical symptoms and imaging findings. In addition, we evaluated intraoperative findings in patients who had undergone surgery. A follow-up study was conducted for at least 1 year.
  
  
  RESULTS
  Five patients (7 ankles) (mean age 57.8 years) were diagnosed as have TTS, with a mean dialysis duration of 23.4 years (range, 7-30 years). With conservative treatment consisting of rest and a steroid injection, 4 ankles showed improvement. Surgery was performed on 3 ankles. Amyloidoma, nodular tumor fragile deposits in the soft tissue or thecal surface, proliferation of the synovial tendon sheath, and thickened joint capsule were recognized in 3 ankles, and a concomitant ganglion was recognized in 1 ankle. Histologically, the deposition of hyaline material was recognized in all tissues, including the walls of the ganglion or joint capsule, by staining to a pale red color using Congo red stain. An immunohistochemical study indicated positive staining by β-2 microglobulin staining. The flexor retinaculum was thin in all cases, with retinaculum-like thickness not found in carpal tunnel syndrome.
  
  
  CONCLUSIONS
  We believe that the occurrence of TTS in dialysis patients was 0.5%, with a tendency to be more prevalent among patients undergoing maintenance dialysis for 5 or more years. The pathological process of TTS may be different from that of carpal tunnel syndrome.
  
  
  METHODS
  Level IV, retrospective case series.
authors.affiliation: Department of Orthopaedics, Kyoto Prefectural University of Medicine, Kyoto, Japan.
authors.forename: Kan
authors.initials: K
authors.lastname: Imai
authors.forename: Kazuya
authors.initials: K
authors.lastname: Ikoma
authors.forename: Ryo
authors.initials: R
authors.lastname: Imai
authors.forename: Hiroyoshi
authors.initials: H
authors.lastname: Fujiwara
authors.forename: Masamitsu
authors.initials: M
authors.lastname: Kido
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Hara
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Ono
authors.forename: Toshikazu
authors.initials: T
authors.lastname: Kubo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003952:Diagnostic Imaging; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000009:adverse effects*; D012189:Retrospective Studies; D013641:Tarsal Tunnel Syndrome / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy*; D016896:Treatment Outcome