Radin E L
Clin Orthop Relat Res. 1983 Dec(181):167-70.
In 14 patients tarsal tunnel syndrome was associated with varus heels and pronated, splayed forefeet. Review of the literature and the author's experience suggest that these conditions may be a common cause of the tarsal tunnel syndrome. Treatment of fixed varus deformities of the heel by outer heel wedges has been shown to be ineffective. Although outer heel wedges provide symptomatic relief in patients with relatively flexible hindfeet, surgical release of the flexor retinaculum behind the medial malleolus is the treatment of choice in patients who have the tarsal tunnel syndrome with planovarus deformity and is successful in more than 90% of cases. The tarsal tunnel syndrome, in the author's experience, is grossly underdiagnosed. Tarsal tunnel syndrome should be suspected in patients who have pain in the bottom of the feet without localized forefoot tenderness, who have a varus heel and a pronated, splayed forefoot, and who have a positive Tinel's sign behind the medial malleolus. It is important to differentiate tarsal tunnel syndrome from a peripheral neuropathy that obviously will not respond to surgical intervention.
在14例患者中，跗管综合征与足跟内翻以及前足旋前、外展有关。文献回顾及作者的经验表明，这些情况可能是跗管综合征的常见病因。已证明使用足跟外侧楔形垫治疗足跟固定性内翻畸形无效。尽管足跟外侧楔形垫能为后足相对灵活的患者缓解症状，但对于患有跗管综合征伴扁平内翻畸形的患者，在内侧踝后方进行屈肌支持带手术松解是首选治疗方法，且在超过90%的病例中取得成功。根据作者的经验，跗管综合征被严重漏诊。对于足底疼痛但前足无局限性压痛、足跟内翻且前足旋前、外展，以及在内侧踝后方Tinel征阳性的患者，应怀疑跗管综合征。将跗管综合征与显然对手术干预无反应的周围神经病变区分开来很重要。
