Post-operative patient satisfaction after tarsal tunnel decompression

M.K. Aly, P. Dearden, A. Shenolikar, W. Gareth, S.W. Sturdee

Introduction: Tarsal tunnel syndrome (TTS) is a compressive neuropathy of the tibial nerve within the fibro-osseus tibial tunnel posterior and inferior to the medial malleolus. This study examines the management of TTS in a secondary care setting correlating duration of symptoms and the investigations organised and with clinical outcome and patient satisfaction.

Methods: Retrospective case note review of 30 patients diagnosed with TTS who underwent 34 tarsal tunnel decompression procedures between April 2008 and April 2011 at Calderdale and Huddersfield NHS Trust. Data collected included duration of symptoms, presence of Tinel’s sign, ratio of patients undergoing nerve conduction studies and other imaging modalities. Clinical outcome was recorded from clinic letters. In 2013, 24 patients were interviewed using the validated Association of Foot and Ankle Surgery Outcome Survey about pain, activity and level of function. Patient satisfaction and recommendation to relatives with surgery were recorded.

Results: Out of the 30 patients, 16 were male with average age 54 (21-83). 18 patients were symptomatic for more than 12 months. For the remainder, the average was 4.6 months. 18 patients were positive for Tinel’s sign. All patients underwent nerve conduction studies. Median duration between initial presentation and surgery was 174 days. 24 patients demonstrated good outcome up till discharge. 3 patients showed slight improvement. Median time for follow-up was 1212 days. 17 (70.8%) said they were satisfied with the surgery. 15 (62.5%) patients said they experienced no to mild, occasional pain. 13 (54.1%) patients said they faced no limitation in their daily activities. 16 (66.6%) patients said they could walk between 4-6 or greater than 6 blocks (1/3 mile) non-stop.

Conclusion: Tarsal tunnel decompression offers symptomatic relief to most patients. Most patients enjoy a good quality of life post-operatively. Further research is needed to understand why satisfactory outcomes are sometimes not achieved.