The Clinical Study Of Tarsal Tunnel Syndrome

Tarsal Tunnel Syndrome is the branches, Terminal branch of the tibia nerve which compressed in the tunnel. The report about TTS is later than Median nerve Compression lead to Carpal tunnel syndrome and ulnar nerve Compression lead to cubital tunnel syndrome. In recent years, in pace with increasing the report and well-informed about TTS, the knowledge of TTS is sophisticated. The clinical performance of TTS is indisposed of malleolus,pain,torpor, after Standing or walking a long time , performance is increasing; After resting or taking off shoes, performance is easing. In serious cases, the site of persistent burning pain, history of waking up at night because of pain, dry skin and less perspiration. Dorsiflexion and eversion testing five to ten seconds can induce the performance which is not obvious, can increase the performance which is existing. In surgical operation, we find that the tibia nerve in dorsiflexion and eversion position is intensity. The positive rate of can reach 100%, specificity and accuracy is high. We believe that clinical examination can be generally applied. The use of nerve electromyography, including muscles'fibrillation potential and positive wave, also include tibia nerve conduction velocity. High-frequency ultrasound can display whether the tibia nerve is lesions. At present, the diagnosis of tarsal tunnel syndrome is not difficultly, Treatment can be divided into Conservative treatment and surgical treatment. Clinical academics are more concerned about the surgical treatment of TTS, and the conservative treatment was not attracted enough attention. Observation after TTS treatment, Cimino reported that a group of cases that only 65% need surgical treatment, Pfeiffer for long-term effectiveness of surgical treatment, the use of rigorous testing and accurate method for the follow-up of patients, not satisfied with the results. For patients with no obvious symptoms, we use conservative treatment. For patients with obvious symptoms, we adopt a positive surgical treatment. The Posterior tibia never adventitia release is my most commonly used surgical in my hospital. The effect of postoperative is certainly.The purpose of this study was to explore th effectiveness of surgical in Tarsal Tunnel Syndrome patients with early line epineurium of the release and the related issues of the tarsal tunnel syndrome. This study use a retrospective method. The collection of my division from August 2006 to January 2009, 18 sides of 16 cases of lateral tarsal tunnel syndrome. Summarized of this group cases by disease history, relevant medical history, occupation . The patients were divided into three groups in accordance with the performance of clinical symptoms of neurological disorders,13 cases of early, 2 cases of medium-term, 1 cases of the late. In the physical examination of patients, We use hallux dorsiflexion test ,results showed that rate of patients with positive is 100%, then all confirmed by intraoperative. EMG provide a reliable basis for determining the site or the extent of the tibial nerve We generally use the medial malleolus the rear of the arc-shaped incision 1.5cm forward,8cm long,A thorough exploration of the tibial nerve and the medial branch and its terminal branch, lateral plantar nerve and Medial plantar nerve. Focus on detecting a few nerve compression point. Epineurial release 14 cases in this group, Perineurium release 4 cases. Giving nutritional nerve, early activities, neurological rehabilitation after operating. Homogeneous in this group of patients with wound healing, no infection. Follow-up of patients after 1 month and 3 months respectively, Evaluation follow-up results according to the Chinese Medical Association Society of Hand Surgery nerves around the restoration of neurological function of traditional criteria. Elearly Epineurium release after 1 month we can see the good rate was 64.28%. after 3 months an excellent rate is 78.57 percent, the effect of is satisfaction. Perineurium release a month the resumption is poor, but after 3 months we can see the improve. Two typical cases cited. In the discussion, discussed 1. The positioning of Tarsal tunnel syndrome, the first tarsal tunnel means that the traditional else proximal tarsal tunnel. The last century of 80's propose the definition of proximal tarsal tunnel and distal tarsal tunnel. Recently, some academics have suggested that tarsal tunnel should include Possession of a high ankle and the proximal tarsal tunnel and proximal tarsal tunnel and distal tarsal tunnel,but not seen in clinical, not mentioned in the literature at home and abroad else, We believe that the significance of possession of a high ankle guidance on the clinical to be further research.2 Double compression of TTS, Present study has confirmed the existence of Double compression,In guiding the clinical workers should complete explorat of tibial nerve is meaningful.3 Compression of Ankle tube location and factor analysis, through the surgery patients and access to relevant documents of the tibial nerve clear , the easy parts and compression factor of tibial nerve is clearly.4 the relationship of the medial branch of tibial nerve compression between heel pain. the medial branch of tibial nerve compression can lead to heel pain, The patients with heel pain, We should consider in conjunction with the compression of the medial branch after exclusion of other causes.5the cure of TTS, conservative treatment does not solve the nerve compression factor, conservative treatment alleviate the symptoms is temporarily, Can not stop the progress of the disease, at the same time also shows the need for early surgical treatment. through surgical cases and relevant documentation wo consider that epineurial release surgery is an effective way. Conclusion is The tarsal tunnel syndrome in patients with early surgical treatment,after eliminating the causes, basis of a thorough exploration of tibial nerve, the effect of epineurial release surgery is certainly.