Tarsal Tunnel Syndrome: Outcomes and Predictive Factors After a Minimum of 5-Year Follow-up Post-Treatment

Abstract

Background

This study aimed to evaluate outcomes after a minimum 5-year follow-up of feet with tarsal tunnel syndrome (TTS) after electroneuromyographic (ENMG) diagnosis and treatment. Possible predictive factors of outcome were sought.

Methods

All patients underwent, at the least, initial clinical evaluation, ENMG diagnosis, ultrasound and medical treatment for TTS. If treatment was unsuccessful after 6 months, tibial nerve release was proposed. Outcomes were classified as satisfactory (excellent and good) or unsatisfactory (fair and poor) based on Pfeiffer’s classification.

Results

Seventy-six feet received conservative treatment, with 65% of satisfactory outcomes, rising to 78% in case of additional tibial nerve release (16 feet, 21%, excellent results in 10 of 76 feet). Improvement was insufficient in 14% of feet, but the patients did not consider that surgery was necessary. Five years after medical treatment, outcome was satisfactory in 5 of 8 feet with nerve contact on ultrasound within the tarsal tunnel, and in 9 of 10 feet with isolated talus-nerve contact. Finally, 18% of feet had nerve contact on ultrasonography and a satisfactory outcome after conservative treatment when evaluated after a minimum of 5 years. Results tended to be better in the absence of static disorders (P = .058), hindfoot varus in particular (P = .032), and in women (P = .047).

Conclusions

Conservative treatment of TTS yielded satisfactory outcomes at 5-year follow-up. Except in rare cases, it should be the first-line treatment even when nerve contact is seen on imaging. Surgical release appeared to be beneficial after failure of medical treatment at 6 months. Outcomes appeared poorer in feet with static disorders and better in women.

Levels of Evidence:

Therapeutic, Level IV, Retrospective