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Failed Tarsal Tunnel
ReleaseEllianne Nasser, DPM, FACFAS, CWS
Podiatry Associate, Department of Orthopaedics
Geisinger Health System
Assistant Program Director, Podiatric Medicine and Surgery Residency
Geisinger Community Medical Center
Success Rates/Timing of Procedure
• Success rates 44%-96%
• Continued compression intraneural fibrosis muscle atrophy and irreparable nerve damage
• Better outcomes with symptoms < 1 year
• Sammarco/Chang 75 TTR
• Results favorable if symptoms < 1 year
• Babba et al 34 TTR
• 61% relief of symptoms after TTR with “longstanding symptoms”
• Turan et al 18 TTR
Technique Pearls/Pitfalls
• Bleeding wound dehiscence and post-op scarring
• Drop tourniquet
• Consider drain
• Evacuate seroma/hematoma in timely fashion
• Correct Etiology
• Minimal manipulation of nerve
No Improvement – Double Crush Syndrome
• Systemic disease
• Radiculopathy/Plexopathy
• Proximal tibial nerve compression
Proximal Tibial Nerve Compression
• Soleal Sling Syndrome
• Severe POP calf 9cm
distal to popliteal crease
• Conduction block btwn
stimulation at knee and
ankle
No Improvement:
Etiology not Addressed
• Space occupying lesions
• Hindfoot deformity
• Varicosities
• Neurilemoma
• Hypertrophic flexor retinaculum
• Post-traumatic fibrosis
• Low-lying muscle belly
Temporary Relief with Recurrence:
Adhesive Neuritis
• Relief 2-4 months then return of symptoms
• Post-op joint motion scarring
• Nerve adhesions prevent gliding traction neuritis/pain
• Risk factors
• Tender, hypertrophic scar, decreased joint mobility
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