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

Geoffrey K. Seidel; Salma Al Jamal; Eric Weidert; Frederick Carington; Michael T. Andary; Scott R. Millis; Brian G. Loder

doi:10.1055/s-0041-1731747

Journal of Brachial Plexus and Peripheral Nerve Injury, Table of Contents

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

¹Department 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

²Department of Obstetrics and Gynecology, Advocate Aurora Health, Aurora Healthcare, Milwaukee, Wisconsin, United States

,

Eric Weidert

³Department 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

³Department 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

³Department 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

⁴Department of Physical Medicine and Rehabilitation, School of Medicine, Wayne State University, Detroit, Michigan, United States

,

Brian G. Loder

⁵Department of Orthopaedics, College of Osteopathic Medicine, Henry Ford Macomb Hospital, Michigan State University, Clinton Twp., Michigan, United States

› Author Affiliations

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

Full Text

References

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