Eric H Williams1, Gedge D Rosson, Robert R Hagan, Shahreyar S Hashemi, A Lee Dellon. 1. Baltimore, Md.; and St. Louis, Mo. From the Department of Plastic, Reconstructive, and Maxillofacial Surgery, The Johns Hopkins University; the Dellon Institute for Peripheral Nerve Surgery; and St. Louis Plastic and Hand Surgery.
Abstract
BACKGROUND: Although distal tibial nerve compression is well recognized, proximal tibial nerve compression remains a rarely recognized clinical condition. This report defines the presentation, diagnosis, surgical decompression technique, and clinical outcome of neurolysis of the tibial nerve at this soleal sling compression site. METHODS: Forty-nine patients with 69 proximal tibial nerves (20 bilateral) were stratified retrospectively into three groups: neuropathy (n = 10), failed tarsal tunnel syndrome (n = 25), and trauma (n = 14). Pain level, strength of the flexor hallucis longus muscle, neurosensory testing of the hallux, and subjective sensory improvement were evaluated. Each proximal tibial nerve compression was subjected to neurolysis with division of the soleal sling. RESULTS: Results were stratified into poor, fair, good, and excellent based on the amount of pain relief and improvement in motor and sensory function. In all groups combined, there were 13 excellent (26.5 percent), 13 good (26.5 percent), 18 fair (36.7 percent), and five poor (10.2 percent) results. Results in the neuropathy group were excellent in two patients, good in three, fair in four, and poor in one (mean follow-up, 18.7 months). Results in the failed tarsal tunnel syndrome group were excellent in two, good in six, fair in 13, and poor in four patients (mean follow-up, 13.9 months). The trauma subgroup had the best outcomes: excellent in nine patients, good in four, fair in one, and poor in zero (mean follow-up, 13.4 months). CONCLUSION: Regardless of cause, if a proximal tibial nerve compression beneath the soleal sling is identified, neurolysis may improve pain and sensory and motor function. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
BACKGROUND: Although distal tibial nerve compression is well recognized, proximal tibial nerve compression remains a rarely recognized clinical condition. This report defines the presentation, diagnosis, surgical decompression technique, and clinical outcome of neurolysis of the tibial nerve at this soleal sling compression site. METHODS: Forty-nine patients with 69 proximal tibial nerves (20 bilateral) were stratified retrospectively into three groups: neuropathy (n = 10), failed tarsal tunnel syndrome (n = 25), and trauma (n = 14). Pain level, strength of the flexor hallucis longus muscle, neurosensory testing of the hallux, and subjective sensory improvement were evaluated. Each proximal tibial nerve compression was subjected to neurolysis with division of the soleal sling. RESULTS: Results were stratified into poor, fair, good, and excellent based on the amount of pain relief and improvement in motor and sensory function. In all groups combined, there were 13 excellent (26.5 percent), 13 good (26.5 percent), 18 fair (36.7 percent), and five poor (10.2 percent) results. Results in the neuropathy group were excellent in two patients, good in three, fair in four, and poor in one (mean follow-up, 18.7 months). Results in the failed tarsal tunnel syndrome group were excellent in two, good in six, fair in 13, and poor in four patients (mean follow-up, 13.9 months). The trauma subgroup had the best outcomes: excellent in nine patients, good in four, fair in one, and poor in zero (mean follow-up, 13.4 months). CONCLUSION: Regardless of cause, if a proximal tibial nerve compression beneath the soleal sling is identified, neurolysis may improve pain and sensory and motor function. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.