What is the efficacy of surgery for posterior tibial nerve entrapment?

Updated: Oct 15, 2019
  • Author: Minoo Hadjari Hollis, MD; Chief Editor: Thomas M DeBerardino, MD  more...
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Answer

In a report of operative results from patients with recalcitrant heel pain, Baxter and Thigpen performed a full release of the lateral plantar nerve and its branches with minimal or no plantar fascia release. [5] The two most common areas of compression were noted at the sharp fascial edge of the abductor hallucis and at the medial ridge of the calcaneus where the nerve passes over it beneath the tuberosity or origin of the flexor brevis and plantar fascia.

Of the 34 heels that were operated on in this study, 32 had good results and two had poor results. [5] Most patients could detect improvement during the first or second postoperative day. Anti-inflammatory medication and orthosis use were continued postoperatively.

Watson et al reported good-to-excellent results in 84% of patients who underwent distal tarsal tunnel release and partial plantar fasciotomy. [59] Bailie and Kelikian reported that 84% of their patients in the noncompensation group were very satisfied or moderately satisfied with the outcome. [60] They also reported better satisfaction in patients with nontraumatic etiology than in others.

Sammarco and Chang, reporting on 108 ankles with posterior tibial nerve entrapment, found that patients with symptoms lasting less than 1 year had significantly better postoperative scores than did patients who had symptoms for more than 1 year before surgery. [22] They did not observe an effect of trauma on the outcome of surgery, and they noted that improvement was predictable even when a space-occupying lesion was not identified at surgery.

In one study, revision tarsal tunnel surgery was performed on 44 patients (two bilaterally), including the following components [61] :

  • Neurolysis of the tibial nerve in the tarsal tunnel and of the medial plantar, lateral plantar, and calcaneal nerves in their respective tunnels
  • Excision of the intertunnel septum
  • Neuroma resection as indicated

A painful tarsal tunnel scar and a painful heel were treated by resection of the distal saphenous nerve and resection of a calcaneal nerve branch, respectively.

Patient-satisfaction ratings in this study were 54% excellent, 24% good, 13% fair, and 9% poor. [61] Prognostic indicators of poor results were coexisting lumbosacral disc disease and neuropathy. The authors noted that an approach related to resecting painful cutaneous nerves and neurolysis of all tibial nerve branches at the ankle may offer hope for relief of pain and recovery of sensation for the majority of patients in whom previous tarsal tunnel surgery has failed.


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