title: Earthquake generated proximal tibial nerve compression treated by surgery.
abstract: OBJECTIVE
  This article reports on nine cases of proximal tibial nerve compression by the soleal tendinous arch caused by unsuitable treatment of acute compartment syndrome (ACS). Also, we report the clinical results of neurolysis and analyse the cause of this special type of neurological compression.
  
  
  METHODS
  There were nine extremities in nine patients included in the study. All patients were among the victims of the Wenchuan earthquake in 2008. All patients had a previous lower extremity ACS. Pain level, numbness in the sole, muscle strength of the flexor hallucis longus and Tinel's sign were evaluated pre- and post-operatively. Each proximal tibial nerve compression was subjected to neurolysis with division of the soleal tendinous arch.
  
  
  RESULTS
  At a mean follow-up of 22 months, eight patients (87 %) with weakness of the flexor hallucis longus showed improvement in flexor strength and seven patients (78 %) exhibited improved sensory function in the sole. All patients experienced pain relief. Subjective pain was reduced from an average score of 2.7 to 0.7 based on a visual analogue scale. Physical examination for Tinel's sign revealed all patients experienced relief of radiating pain, but two patients still retained a positive Tinel's sign (mild) over the soleal tendinous arch. In summary, four patients were highly satisfied, four were satisfied and one was neither satisfied nor dissatisfied with functional recovery after neurolysis.
  
  
  CONCLUSIONS
  Unsuitable treatment of lower extremity ACS can lead to tibial nerve compression beneath the soleal tendinous arch. Neurolysis may improve pain and sensory and motor function.
authors.affiliation: Department of Orthopaedics, General Hospital, Beijing, China.
authors.forename: Peifu
authors.initials: P
authors.lastname: Tang
authors.forename: Qing
authors.initials: Q
authors.lastname: He
authors.forename: Chao
authors.initials: C
authors.lastname: Chen
authors.forename: Xianfei
authors.initials: X
authors.lastname: Liu
authors.forename: Lihai
authors.initials: L
authors.lastname: Zhang
mesh_terms: D000328:Adult; D002681:China; D003161:Compartment Syndromes / Q000209:etiology / Q000601:surgery; D055866:Earthquakes; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009407:Nerve Block; D009408:Nerve Compression Syndromes / Q000209:etiology* / Q000601:surgery*; D010147:Pain Measurement; D017060:Patient Satisfaction; D020127:Recovery of Function; D012189:Retrospective Studies; D013979:Tibial Nerve / Q000293:injuries* / Q000502:physiology; D020429:Tibial Neuropathy / Q000209:etiology* / Q000601:surgery*; D016896:Treatment Outcome