Vij Neeraj, Kaley Heather N, Robinson Christopher L, Issa Peter P, Kaye Alan D, Viswanath Omar, Urits Ivan
University of Arizona College of Medicine - Phoenix.
Creighton University School of Medicine.
Orthop Rev (Pavia). 2022 Sep 5;14(3):37539. doi: 10.52965/001c.37539. eCollection 2022.
Posterior tarsal tunnel syndrome involves entrapment of the posterior tibial nerve as it travels in the groove posterior to the medial malleolus. Conventional wisdom dictates that patients with tarsal tunnel syndrome be treated with conservative treatment and medical management, with surgical options available for patients with refractory symptoms and good candidacy. Minimally invasive options for neuropathic entrapment syndromes have developed in recent years and may provide a therapeutic role in tarsal tunnel syndrome.
The present investigation provides a summary of the current state of knowledge on tarsal tunnel syndrome and a comparison between minimally invasive and surgical treatment options.
The literature search was performed in Mendeley. Search fields were varied until redundant. All articles were screened by title and abstract and a preliminary decision to include an article was made. A full-text screening was performed on the selected articles. Any question regarding the inclusion of an article was discussed by 3 authors until an agreement was reached.
Most commonly tarsal tunnel syndrome is idiopathic. Other reported causes include post-traumatic, lipomas, cysts, ganglia, schwannomas, ganglia, varicose plantar veins, anatomic anomalies, and systematic inflammatory conditions. Several risk factors have been described including female gender, athletic participation, hypothyroidism, diabetes mellitus, systemic sclerosis, chronic renal failure, and hemodialysis use. A few recent studies demonstrate anatomic variants that have not previously been summarized. Three articles describe clinical outcomes after conservative treatment with acceptable results for first line treatment. Two primary articles report on the use of minimally invasive treatment for tarsal tunnel syndrome. Fourteen articles report on the clinical outcomes after surgical management.
Clinical understanding of tarsal tunnel syndrome has evolved significantly, particularly with regards to the pathoanatomy of the tarsal canal over the past twelve years. A few novel anatomic studies shed light on variants that can be helpful in diagnosis. Conservative management remains a good option that can resolve the symptoms of many patients. As more prospective cohorts and clinical trials are performed on minimally invasive options, pulsed radiofrequency and neuromodulation may evolve to play a larger role in the treatment of this condition. Currently, surgical treatment is only pursued in a very select group of patients with refractory symptoms that do not respond to medical or minimally invasive options. Surgical outcomes in the literature are good and current evidence is stronger than that for minimally invasive options.
跗管综合征是指胫后神经在内踝后方的沟内走行时受到卡压。传统观点认为，跗管综合征患者应先接受保守治疗和药物治疗，对于症状难治且具备良好手术指征的患者可选择手术治疗。近年来，针对神经卡压综合征出现了一些微创治疗方法，这些方法可能在跗管综合征的治疗中发挥作用。
本研究对跗管综合征的当前知识状况进行了总结，并比较了微创治疗与手术治疗方法。
在Mendeley中进行文献检索。不断变换检索字段直至无冗余。所有文章先通过标题和摘要进行筛选，并初步决定是否纳入。对选定的文章进行全文筛选。任何关于文章纳入的问题由三位作者共同讨论，直至达成一致。
跗管综合征最常见的病因是特发性的。其他报道的病因包括创伤后、脂肪瘤、囊肿、腱鞘囊肿、神经鞘瘤、静脉曲张、解剖异常以及系统性炎症性疾病。已描述了多种危险因素，包括女性、运动参与、甲状腺功能减退、糖尿病、系统性硬化症、慢性肾功能衰竭以及血液透析。最近的一些研究证实了一些以前未总结过的解剖变异。三篇文章描述了保守治疗后的临床结果，作为一线治疗取得了可接受的效果。两篇主要文章报道了跗管综合征的微创治疗应用。十四篇文章报道了手术治疗后的临床结果。
在过去的十二年中，对跗管综合征的临床认识有了显著进展，尤其是在跗管的病理解剖方面。一些新的解剖学研究揭示了有助于诊断的变异。保守治疗仍然是一个很好的选择，可以缓解许多患者的症状。随着对微创治疗方法进行更多的前瞻性队列研究和临床试验，脉冲射频和神经调节可能会在这种疾病的治疗中发挥更大的作用。目前，仅对极少数症状难治且对药物或微创治疗无效的患者采用手术治疗。文献中的手术治疗效果良好，当前证据表明其比微创治疗方法更具优势。
