Results of decompression of four medial ankle tunnels in the treatment of tarsal tunnels syndrome.

Controversy surrounds the surgical approach and efficacy for tibial nerve compression at the ankle. The hypotheses tested are that the poor published results are due to failure to recognize that the tarsal tunnel is analogous to the forearm, not the carpal tunnel, and that postoperative ankle immobilization contributes to poor results by permitting fibrosis of the tibial nerve branches. From January of 1987 through December of 1994, a consecutive series of 77 patients with tarsal tunnel syndrome was accrued, 10 of whom had the condition bilaterally. The surgical approach included a neurolysis of the tibial nerve in the tarsal tunnel and the medial, lateral plantar, calcaneal nerves in their own tunnels. Postoperatively, immediate weight bearing and ambulation were permitted in a bulky cotton dressing. The dressing was removed at 1 week. For the 87 legs, mean follow-up after surgery was 3.6 years. Utilizing the traditional postoperative assessment, there were 82% excellent, 11% good, 5% fair, and 2% poor results. Utilizing a numerical grading scale, there was a statistically significant improvement at the P<0.001 level for sensory and also for motor impairment. Recognition that decompression of four medial ankle tunnels and immediate postoperative mobilization of the tibial nerve through ambulation is necessary results in a high level of success for patients with tarsal tunnels syndrome.