Dellon A Lee
Plastic Surgery and Neurosurgery, Johns Hopkins University, Baltimore, MD, USA.
Neurosurg Clin N Am. 2008 Oct;19(4):629-48, vii. doi: 10.1016/j.nec.2008.07.003.
The mechanisms of symptom production (other than a space-occupying lesion) and the diagnosis of tarsal tunnel syndrome remain controversial. To understand the diagnosis and treatment of tarsal tunnel syndrome in the presence of neuropathy, the known anatomy and pathophysiology related to the tarsal tunnel and the existing basic science and clinical evidence base related to these topics are reviewed. It is concluded that it is difficult to identify patients with tibial nerve compression at the ankle or foot region reliably with traditional electrodiagnostic techniques, even in the absence of neuropathy, and that the presence of a positive "Tinel" sign over the tibial nerve in the tarsal tunnel can identify this as a site of chronic nerve compression. For patients with tarsal tunnel syndrome and the comorbidity of diabetic polyneuropathy (DPN), it is concluded that a positive Tinel sign at the tarsal tunnel can predict a positive outcome for pain relief and restoration of sensation in 80% of the people who have decompression of the four medial ankle tunnels. With sensation improved, it is concluded that the natural history of DPN can be changed toward prevention of ulcers and amputation.
跗管综合征（不包括占位性病变）的症状产生机制及诊断仍存在争议。为了解在存在神经病变情况下跗管综合征的诊断与治疗，本文回顾了与跗管相关的已知解剖结构和病理生理学，以及与这些主题相关的现有基础科学和临床证据。结论是，即使在没有神经病变的情况下，使用传统电诊断技术也很难可靠地识别出踝部或足部区域胫神经受压的患者，而跗管内胫神经上出现阳性“Tinel”征可将此识别为慢性神经受压部位。对于患有跗管综合征且合并糖尿病性多发性神经病变（DPN）的患者，结论是跗管处的阳性Tinel征可预测80%接受内侧踝部四条隧道减压术的患者疼痛缓解和感觉恢复的阳性结果。随着感觉改善，结论是DPN的自然病程可朝着预防溃疡和截肢的方向改变。
