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CC BY 4.0 · J Brachial Plex Peripher Nerve Inj 2021; 16(01): e37-e45
DOI: 10.1055/s-0041-1731747
Original Contribution

Predictive Outcome Modeling of Preoperative Clinical Symptoms and Electrodiagnostic Data in Tarsal Tunnel Surgery

Geoffrey K. Seidel 
1   Department of Physical Medicine and Rehabilitation, Wayne State University School of Medicine, Michigan State University College of Osteopathic Medicine, Henry Ford Macomb Hospital, Clinton Township, Michigan, United States
,
Salma Al Jamal
2   Department of Obstetrics and Gynecology, Advocate Aurora Health, Aurora Healthcare, Milwaukee, Wisconsin, United States
,
Eric Weidert
3   Department of Physical Medicine and Rehabilitation, College of Osteopathic Medicine, Sparrow Hospital, Michigan State University, McLaren Hospital of Greater Lansing, Lansing, Michigan, United States
,
Frederick Carington
3   Department of Physical Medicine and Rehabilitation, College of Osteopathic Medicine, Sparrow Hospital, Michigan State University, McLaren Hospital of Greater Lansing, Lansing, Michigan, United States
,
Michael T. Andary
3   Department of Physical Medicine and Rehabilitation, College of Osteopathic Medicine, Sparrow Hospital, Michigan State University, McLaren Hospital of Greater Lansing, Lansing, Michigan, United States
,
Scott R. Millis
4   Department of Physical Medicine and Rehabilitation, School of Medicine, Wayne State University, Detroit, Michigan, United States
,
Brian G. Loder
5   Department of Orthopaedics, College of Osteopathic Medicine, Henry Ford Macomb Hospital, Michigan State University, Clinton Twp., Michigan, United States
› Author Affiliations Funding None.
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Abstract

Background The relationship between tarsal tunnel syndrome (TTS), electrodiagnostic (Edx) findings, and surgical outcome is unknown. Analysis of TTS surgical release outcome patient satisfaction and comparison to Edx nerve conduction studies (NCSs) is important to improve outcome prediction when deciding who would benefit from TTS release.

Methods Retrospective study of 90 patients over 7 years that had tarsal tunnel (TT) release surgery with outcome rating and preoperative tibial NCS. Overall, 64 patients met study inclusion criteria with enough NCS data to be classified into one of the following three groups: (1) probable TTS, (2) peripheral polyneuropathy, or (3) normal. Most patients had preoperative clinical provocative testing including diagnostic tibial nerve injection, tibial Phalen's sign, and/or Tinel's sign and complaints of plantar tibial neuropathic symptoms. Outcome measure was percentage of patient improvement report at surgical follow-up visit.

Results Patient-reported improvement was 92% in the probable TTS group (n = 41) and 77% of the non-TTS group (n = 23). Multivariate modeling revealed that three out of eight variables predicted improvement from surgical release, NCS consistent with TTS (p = 0.04), neuropathic symptoms (p = 0.045), and absent Phalen's test (p = 0.001). The R 2 was 0.21 which is a robust result for this outcome measurement process.

Conclusion The best predictors of improvement in patients with TTS release were found in patients that had preoperative Edx evidence of tibial neuropathy in the TT and tibial nerve plantar symptoms. Determining what factors predict surgical outcome will require prospective evaluation and evaluation of patients with other nonsurgical modalities.

Keywords

tarsal tunnel syndrome - nerve conduction - medial plantar nerve - lateral plantar nerve - surgery - outcome modeling


Publication History

Received: 05 January 2021

Accepted: 31 March 2021

Article published online:
27 July 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Lau JTC, Daniels TR. Tarsal tunnel syndrome: a review of the literature. Foot Ankle Int 1999; 20 (03) 201-209
    CrossrefPubMedSearch in Google Scholar
  • 2 Oh SJ, Arnold TW, Park KH, Kim DE. Electrophysiological improvement following decompression surgery in tarsal tunnel syndrome. Muscle Nerve 1991; 14 (05) 407-410
    CrossrefPubMedSearch in Google Scholar
  • 3 Patel AT, Gaines K, Malamut R, Park TA, Toro DR, Holland N. American Association of Neuromuscular and Electrodiagnostic Medicine. Usefulness of electrodiagnostic techniques in the evaluation of suspected tarsal tunnel syndrome: an evidence-based review. Muscle Nerve 2005; 32 (02) 236-240
    CrossrefPubMedSearch in Google Scholar
  • 4 Kaplan PE, Kernahan Jr WT. Tarsal tunnel syndrome: an electrodiagnostic and surgical correlation. J Bone Joint Surg Am 1981; 63 (01) 96-99
    CrossrefPubMedSearch in Google Scholar
  • 5 Mondelli M, Giannini F, Reale F. Clinical and electrophysiological findings and follow-up in tarsal tunnel syndrome. Electroencephalogr Clin Neurophysiol 1998; 109 (05) 418-425
    CrossrefPubMedSearch in Google Scholar
  • 6 Ward PJ, Porter ML. Tarsal tunnel syndrome: a study of the clinical and neurophysiological results of decompression. J R Coll Surg Edinb 1998; 43 (01) 35-36
    PubMedSearch in Google Scholar
  • 7 Hendrix CL, Jolly GP, Garbalosa JC, Blume P, DosRemedios E. Entrapment neuropathy: the etiology of intractable chronic heel pain syndrome. J Foot Ankle Surg 1998; 37 (04) 273-279
    CrossrefPubMedSearch in Google Scholar
  • 8 Ahmad M, Tsang K, Mackenney PJ, Adedapo AO. Tarsal tunnel syndrome: A literature review. Foot Ankle Surg 2012; 18 (03) 149-152
    CrossrefPubMedSearch in Google Scholar
  • 9 Saeed MA, Gatens PF. Compound nerve action potentials of the medial and lateral plantar nerves through the tarsal tunnel. Arch Phys Med Rehabil 1982; 63 (07) 304-307
    PubMedSearch in Google Scholar
  • 10 Almeida DF, Scremin L, Zúniga SF, Oh SJ. Focal conduction block in a case of tarsal tunnel syndrome. Muscle Nerve 2010; 42 (03) 452-455
    CrossrefPubMedSearch in Google Scholar
  • 11 Galardi G, Amadio S, Maderna L. et al. Electrophysiologic studies in tarsal tunnel syndrome. Diagnostic reliability of motor distal latency, mixed nerve and sensory nerve conduction studies. Am J Phys Med Rehabil 1994; 73 (03) 193-198
    CrossrefPubMedSearch in Google Scholar
  • 12 Delisa JA, Saeed MA. The tarsal tunnel syndrome. AAEE case report #8. Muscle Nerve 1983; 6: 554-570
    CrossrefPubMedSearch in Google Scholar
  • 13 Fu R, DeLisa JA, Kraft GH. Motor nerve latencies through the tarsal tunnel in normal adult subjects: standard determinations corrected for temperature and distance. Arch Phys Med Rehabil 1980; 61 (06) 243-248
    PubMedSearch in Google Scholar
  • 14 Johnson EW, Ortiz PR. Electrodiagnosis of tarsal tunnel syndrome. Arch Phys Med Rehabil 1966; 47 (12) 776-780
    PubMedSearch in Google Scholar
  • 15 Buschbacher RM. Peroneal nerve motor conduction to the extensor digitorum brevis. Am J Phys Med Rehabil 1999; 78 (06) S26-S31
    CrossrefPubMedSearch in Google Scholar
  • 16 Buschbacher RM. Sural and saphenous 14-cm antidromic sensory nerve conduction studies. Am J Phys Med Rehabil 2003; 82 (06) 421-426
    CrossrefPubMedSearch in Google Scholar
  • 17 Saffarian MR, Condie NC, Austin EA. et al. Comparison of four different nerve conduction techniques of the superficial fibular sensory nerve. Muscle Nerve 2017; 56 (03) 458-462
    CrossrefPubMedSearch in Google Scholar
  • 18 Sammarco GJ, Chang L. Outcome of surgical treatment of tarsal tunnel syndrome. Foot Ankle Int 2003; 24 (02) 125-131
    CrossrefPubMedSearch in Google Scholar
  • 19 Bailie DS, Kelikian AS. Tarsal tunnel syndrome: diagnosis, surgical technique, and functional outcome. Foot Ankle Int 1998; 19 (02) 65-72
    CrossrefPubMedSearch in Google Scholar
  • 20 Macaré van Maurik JFM, Franssen H, Millin DW, Peters EJ, Kon M. Nerve conduction studies after decompression in painful diabetic polyneuropathy. J Clin Neurophysiol 2015; 32 (03) 247-250
    CrossrefPubMedSearch in Google Scholar