title: Tarsal Tunnel Syndrome Due To Three Different Types of Ganglion During a 12-Year Period: A Case Report.
abstract: A 52-year-old male complained of numbness and radiating pain affecting the plantar region of his left foot. He was found to have recurrent tarsal tunnel syndrome due to posterior tibial nerve compression by 3 different types of ganglion during a 12-year period. To the best of our knowledge, a similar case has not been documented. At the first operation, flexor retinaculum release and simple excision of an epineural ganglion were performed without injuring the nerve fascicles; however, an intrafascicular ganglion developed approximately 2 years later. At the second operation, the ganglion cyst was resected completely to prevent recurrence, despite the risk of nerve fiber injury. The cyst originated from the subtalar joint; thus, the joint was closed, and a free fat graft was placed to prevent adhesion formation. However, an extraneural ganglion occurred about 3 years later. At the third operation, the cyst was resected completely, and a free periosteal graft was used to close the joint more effectively. No recurrence had developed at 6 years after the third operation. The findings of the present case show the need for long-term monitoring of patients with tarsal tunnel syndrome caused by a ganglion owing to the possibility of recurrence related to different ganglion types.
authors.affiliation: Chief, Department of Plastic and Reconstructive Surgery, Sumiya Orthopaedic Hospital, Wakayama, Japan. Electronic address: kawakatsu@sumiya.or.jp.
authors.forename: Motohisa
authors.initials: M
authors.lastname: Kawakatsu
authors.affiliation: Chief, Department of Plastic and Reconstructive Surgery, Otsu Red Cross Hospital, Shiga, Japan.
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Ishiko
authors.affiliation: Chief Director, Department of Orthopaedic Surgery, Sumiya Orthopaedic Hospital, Wakayama, Japan.
authors.forename: Masafumi
authors.initials: M
authors.lastname: Sumiya
mesh_terms: D045888:Ganglion Cysts / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D013641:Tarsal Tunnel Syndrome / Q000209:etiology*
keywords: epineural ganglion; extraneural ganglion; intrafascicular ganglion; periosteal graft; recurrence; tarsal tunnel syndrome