Barker Allison R, Rosson Gedge D, Dellon A Lee
Division of Plastic Surgery, Johns Hopkins University and Dellon Institute for Peripheral Nerve Surgery, Baltimore, MD, USA.
Foot Ankle Int. 2007 Feb;28(2):250-4. doi: 10.3113/FAI.2007.0250.
Pressure in the tarsal tunnel has been shown to be elevated when the ankle is pronated. We hypothesized that this also would be true for the medial plantar and lateral plantar tunnels because they also are potential sites of nerve compression. Additionally, we hypothesized that decompression surgery, including a release of the superficial and deep fascia of the abductor hallucis muscle and excision of the septum between the medial and lateral plantar tunnels, would decrease the pressure in all three tunnels.
Twelve fresh cadaver legs were obtained, and pressure measurements were made in a variety of ankle positions in the tarsal and medial and lateral plantar tunnels before and after decompression surgery. For the medial and lateral plantar tunnels, pressures were obtained after tunnel roof (deep fascia of the abductor hallucis) incision and after both roof incision and excision of the septum between the two tunnels.
Pressures were significantly elevated in all tunnels with ankle pronation, were significantly decreased in all positions in the tarsal tunnel after decompression, and significantly decreased in most positions in the medial and lateral plantar tunnels after decompression. Septum excision led to additional significant decreases in pressure in some positions.
Pressures within the medial and lateral plantar tunnels and the tarsal tunnel increase significantly with changes in ankle subtalar position. These pressure changes can be significantly decreased by operative release of each of these three tunnels, including excision of the septum between the medial and lateral plantar tunnels.
Symptoms related to chronic compression of the tibial nerve and its branches at the ankle may be relieved by an operative strategy that targets release of multiple anatomic regions of tightness in the medial ankle rather than focusing on the tarsal tunnel alone.
已表明当踝关节内翻时跗管内压力会升高。我们推测内侧足底管和外侧足底管也是如此，因为它们也是神经受压的潜在部位。此外，我们推测减压手术，包括松解拇展肌的浅筋膜和深筋膜以及切除内侧和外侧足底管之间的间隔，会降低所有三个管内的压力。
获取12条新鲜尸体腿，在减压手术前后，于跗管、内侧足底管和外侧足底管的各种踝关节位置进行压力测量。对于内侧和外侧足底管，在切开管顶（拇展肌深筋膜）后以及在切开管顶并切除两管之间的间隔后获取压力。
踝关节内翻时所有管内压力均显著升高，减压后跗管内所有位置压力均显著降低，减压后内侧和外侧足底管的大多数位置压力也显著降低。切除间隔导致某些位置压力进一步显著降低。
内侧和外侧足底管以及跗管内的压力会随着距下关节位置的改变而显著增加。通过对这三个管进行手术松解，包括切除内侧和外侧足底管之间的间隔，这些压力变化可显著降低。
针对踝关节内侧多个解剖部位紧张的手术策略，而非仅关注跗管，可能会缓解与胫神经及其分支在踝关节处慢性受压相关的症状。
