Tarsal tunnel syndrome: a study of the clinical and neurophysiological results of decompression.

Ward PJ, Porter ML. J R Coll Surg Edinb 1998 Feb;43(1):35-6.

The neurophysiological and clinical outcomes of surgical decompression of 22 cases of tarsal tunnel syndrome are analysed. Recent work by Pfeiffer & Cracchiolo has suggested a successful outcome in only 44% of cases. We have reviewed the outcome of surgery both clinically and with the use of nerve conduction studies. Pre- and post-operative motor conduction delays in the plantar nerves are compared with clinical results found both in the clinic and later by a postal questionnaire. Despite careful clinical and neurophysiological assessment prior to a full surgical release, only 42% of patients had a satisfactory outcome. A larger reduction in plantar nerve conduction delay post-operatively corresponded well to an improvement in symptoms. However, we were unable to predict which cases would respond to decompression using clinical or electrophysiological methods. We question the use of nerve conduction studies in the diagnosis of tarsal tunnel syndrome, and also the role of surgery in the management of this condition.