Скачать или смотреть Tarsal Tunnel Syndrome - Everything You Need To Know - Dr. Nabil Ebraheim

Educational video describing the posterior tibial nerve - tarsal tunnel syndrome.
The tarsal tunnel is located just below the medial malleolus of the ankle and is covered with a thick band of ligaments called the flexor retinaculum. The flexor retinaculum protects the structures contained within the tunnel such as the posterior tibial nerve. The structures which also pass through the tiunnel include the posterior tibial artery, the tendons of the tibialis posterior, flexor digitorum longus, and the flexor hallucis longus. Tarsal tunnel syndrome is a compression neuropathy caused by compression of the posterior tibial nerve within the tarsal tunnel.
Tibial nerve compression with tarsal tunnel syndrome is similar to carpal tunnel syndrome which occurs at the wrist. Thickening of the flexor retinaculum causes compression of the posterior tibial nerve.
Diagnosis and treatment of tarsal tunnel syndrome depend on understanding how the tibial nerve branches within the tarsal tunnel.
Nine different branching patterns: A pattern: tibial origin within the tunnel. Nerve innervation form the posterior tibial nerve.
Symptoms of tarsal tunnel syndrome include:
•Pain, burning, numbness, tingling, electric shock sensation typically in and around the ankle or at the bottom of the foot.
•Swelling around the ankle and the foot.
•Positive tinel's sign: tapping on the nerve causes radiation of pain into the medial side of the ankle and possibly the foot.
Possible causes of tarsal tunnel syndrome include:
•Ganglia
•Lipoma
•Diabetes
•Arthritis
•Valgus deformity or flatfoot.
Diagnosis
•Combination of history, examination, and EMG.
•The dorsiflexion-eversion test is described to be helpful in the diagnosis of tarsal tunnel.
•MRI and ultrasound are helpful in seeing ganglia, accessory nerve or compression of the muscle itself.
•EMG can be useful when the operator has experience with this condition.
Treatment
•Surgical release of the tarsal tunnel if nonoperative treatment fails. Best results following surgery when a compressive lesion such as a ganglion cyst is removed.
•Recurrence of tarsal tunnel syndrome is usually caused by inadequate release and repeat tarsal tunnel release is usually not advisable.
•In general, tarsal tunnel decompression may not produce a good long term outcome.

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