STUDY DESIGN: Retrospective study (level of evidence=3). PURPOSE: We examine the relationship between residual symptoms after discectomy for lumbar disc herniation and peripheral nerve (PN) neuropathy. OVERVIEW OF LITERATURE: Patients may report persistent or recurrent symptoms after lumbar disc herniation surgery; others fail to respond to a variety of treatments. Some PN neuropathies elicit symptoms similar to those of lumbar spine disease. METHODS: We retrospectively analyzed data for 13 patients treated for persistent (n=2) or recurrent (n=11) low back pain (LBP) and/or leg pain after primary lumbar discectomy. RESULTS: Lumbar re-operation was required for four patients (three with recurrent lumbar disc herniation and one with lumbar canal stenosis). Superior cluneal nerve (SCN) entrapment neuropathy (EN) was noted in 12 patients; SCN block improved the symptoms for eight of these patients. In total, nine patients underwent PN surgery (SCN-EN, n=4; peroneal nerve EN, n=3; tarsal tunnel syndrome, n=1). Their symptoms improved significantly. CONCLUSIONS: Concomitant PN disease should be considered for patients with failed back surgery syndrome manifesting as persistent or recurrent LBP.
Diskectomy ; Failed Back Surgery Syndrome ; Humans ; Leg ; Low Back Pain ; Lumbosacral Region ; Nerve Compression Syndromes ; Peripheral Nerves ; Peripheral Nervous System Diseases ; Peroneal Nerve ; Retrospective Studies ; Spine ; Tarsal Tunnel Syndrome

There are a few reports on tarsal tunnel syndrome resulting from the intraneural ganglion. Although it can occur through a connection with the adjacent joint, there is no consensus on its pathogenesis and treatment method. This paper reports a case of tarsal tunnel syndrome resulting from the intraneural ganglion of the medial plantar nerve of the tibial nerve.
Consensus ; Ganglion Cysts* ; Joints* ; Methods ; Recurrence* ; Tarsal Tunnel Syndrome* ; Tibial Nerve*

During routine dissection, additional muscular head of extensor digitorum brevis muscle attaching to the third toe and accessory muscle perforated by the branch of the deep peroneal nerve were observed in the right foot of a 71-year-old male cadaver. The additional muscular head originated from the dorsal surface of cuboid bone, and ran parallel with the third tendon of the extensor digitorum brevis muscle. It was conjoined with the third tendon of extensor digitorum brevis at the middle of its course. The accessory muscle was a small muscle which was covered with the muscle belly of the extensor hallucis brevis muscle. It originated from the dorsal surface of the calcaneus, and inserted to the lateral one-third of transverse retinacular band. These two variants were innervated by the branches of deep peroneal nerve. The branches of deep peroneal nerve were compressed under the tendon of extensor hallucis brevis and around the site where the nerve branch perforated the small muscle. The clinical significances of these variations and tendon of extensor hallucis brevis muscle were discussed.
Aged ; Cadaver ; Calcaneus ; Foot ; Head ; Humans ; Male ; Peroneal Nerve ; Tarsal Bones ; Tarsal Tunnel Syndrome* ; Tendons ; Toes

Retinacula are thickenings of deep fascia in the region of joints that hold down the tendons preventing them from bowing out of position. In the region of ankle, number of such retinacula have been described. Retinacula like superior and inferior extensor retinacula have been described which hold down the tendons of leg muscles passing to the foot beneath them. As the extensor tendons of the leg have more distal attachment to the toes, the present study was conducted to ascertain the presence of any additional retinaculum in the mid-foot region, which would tie down the tendons for their effective action at the distal joints. The aim was also to determine the attachments of the retinaculum, if present as well as the structures passing beneath them. Fifty cadaveric feet were dissected carefully for this purpose. Presence of an additional extensor retinaculum distal to the inferior band of inferior extensor retinaculum in the mid-foot region was found in 22 feet. Besides the extensor tendons, medial terminal branch of deep peroneal nerve and dorsalis pedis artery was found to pass beneath the retinaculum. A partial or complete mid-foot retinaculum existed in the mid-foot region covering the tarsometatarsal joints in about half of study population. Functionally, this retinaculum may prevent bowstringing of the extensor tendons, clinically it may predispose to entrapment of deep peroneal nerve mimicking anterior tarsal tunnel syndrome.
Ankle ; Arteries ; Cadaver ; Fascia ; Foot ; Joints ; Leg ; Muscles ; Peroneal Nerve ; Tarsal Tunnel Syndrome ; Tendons ; Toes

Tarsal tunnel syndrome is an entrapment neuropathy of the tibial nerve and its branches within the tarsal tunnel, which usually occurs as a result of a space-occupying lesion, trauma or foot deformity. The typical symptoms are pain and paresthesia of the foot at the dermatome of involved nerve branches, and the diagnosis can be made through careful history taking and physical examination. Treatments include conservative management and surgery. Although the reported results of surgical treatment vary, surgical decompression can yield satisfactory outcomes in cases of tarsal tunnel syndrome with a space-occupying lesion.
Decompression, Surgical ; Diagnosis* ; Foot ; Foot Deformities ; Paresthesia ; Physical Examination ; Tarsal Tunnel Syndrome* ; Tibial Nerve

PURPOSE: Nerve conduction study (NCS) test is a standard diagnostic study of the tarsal tunnel syndrome. The purpose of this study was to determine the relation between the results of the NCS and postoperative clinical results. MATERIALS AND METHODS: From June 2004 to July 2015, 104 patients were diagnosed with tarsal tunnel syndrome and treated surgically. Of 104 patients diagnosed through NCS preoperatively and postoperatively, 41 patients were included in this study. There were 23 male and 18 female patients with mean age of 49.2 years old and the average follow-up period was 15.5 months. NCS, pain visual analogue scale (VAS) score, and subjective satisfaction were examined preoperatively and postoperatively. RESULTS: On the preoperative NCS, 32 patients (78.0%) were positive and 9 patients (22.0%) were negative, and 32 positive NCS patients consisted of 9 positive (28.1%), 16 improved (50.0%), and 7 negative (21.9%) postoperatively. VAS score was 7.4 preoperatively and 4.4 postoperatively. According to satisfaction, there were 8 excellent (19.5%), 21 good (51.2%), 6 fair (14.6%), and 6 poor (14.6%) patients. For 32 patients who were positive on the preoperative NCS, the postoperative VAS score was 4.87 and there were 7 excellent (21.9%), 16 good (50.0%), 4 fair (12.5%), and 5 poor (15.6%) patients. Sixteen patients were negative on the postoperative NCS, with a VAS score of 3.75, 1 excellent (6.3%), 11 good (68.8%), 2 fair (12.5%), and 2 poor (12.5%). There was no statistical correlation between the preoperative NCS and postoperative VAS score (p=0.10), between preoperative NCS and postoperative satisfaction (p=0.799), between preoperative NCS and postoperative VAS score (p=0.487), and between postoperative NCS and postoperative satisfaction (p=0.251). CONCLUSION: For patients diagnosed with tarsal tunnel syndrome and treated surgically, NCS showed little correlation with postoperative result.
Female ; Follow-Up Studies ; Humans ; Male ; Neural Conduction* ; Tarsal Tunnel Syndrome*

Tarsal tunnel syndrome is an entrapment neuropathy of the posterior tibial nerve or its branches in the fibro-osseous tunnel beneath the flexor retinaculum. This pathology is associated with multiple etiologies, including trauma, space-occupying lesions, and impaired biomechanics. We report a case of tarsal tunnel syndrome associated with gout tophi in a patient with untreated gout along with a review of the relevant literature on tarsal tunnel syndrome.
Gout* ; Humans ; Pathology ; Tarsal Tunnel Syndrome* ; Tibial Nerve

OBJECTIVE: To demonstrate the bifurcation pattern of the tibial nerve and its branches. METHODS: Eleven legs of seven fresh cadavers were dissected. The reference line for the bifurcation point of tibial nerve branches was an imaginary horizontal line passing the tip of the medial malleolus. The distances between the reference line and the bifurcation points were measured. The bifurcation branching patterns were categorized as type I, the pattern in which the medial calcaneal nerve (MCN) branched most proximally; type II, the pattern in which the three branches occurred at the same point; and type III, in which MCN branched most distally. RESULTS: There were seven cases (64%) of type I, three cases (27%) of type III, and one case (9%) of type II. The median MCN branching point was 0.2 cm (range, -1 to 3 cm). The median bifurcation points of the lateral plantar nerves and inferior calcaneal nerves was -0.6 cm (range, -1.5 to 1 cm) and -2.5 cm (range, -3.5 to -1 cm), respectively. CONCLUSION: MCN originated from the tibial nerve in most cases, and plantar nerves were bifurcated below the medial malleolus. In all cases, inferior calcaneal nerves originated from the lateral plantar nerve. These anatomical findings could be useful for performing procedures, such as nerve block or electrophysiologic studies.
Cadaver ; Leg ; Nerve Block ; Tarsal Tunnel Syndrome ; Tibial Nerve

Tarsal tunnel syndrome is defined as a compressive neuropathy of the posterior tibial nerve in the tarsal canal. Schwannoma is a benign tumor that arises from the peripheral nerve sheath. It presents as a discrete, often tender, and palpable nodule associated with neurogenic pain or paresthesia when compressed or traumatized. The growth rate is usually slow, and these lesions seldom exceed 2 cm in diameter. In addition, local recurrence occurs less than 5%. We report on a case of tarsal tunnel syndrome caused by a large recurred space-occupying lesion measuring 4.3x2.7x2.7 cm3.
Neurilemmoma* ; Paresthesia ; Peripheral Nerves ; Recurrence ; Tarsal Tunnel Syndrome* ; Tibial Nerve*

The tarsal tunnel is located beneath the flexor retinaculum, which connects the medial malleolus and calacaneus. The tarsal tunnel contains the posterior tibialis tendon, flexor digitorum longus tendon, posterior tibial artery and vein, posterior tibial nerve, and flexor halluces longus tendon. Tarsal tunnel syndrome is a compressive neuropathy of posterior tibial nerve and its branches under the flexor retinaculum. The etiologies of tarsal tunnel syndrome are space-occupying lesion, hypertrophied flexor retinaculum, osteophytes, tarsal coalition, varicose vein, and trauma. The symptoms are foot pain and hypoesthesia or paresthesia at dermatome according to involving nerve branches. Clinical diagnosis can be obtained from a detailed history and physical examination such as compressive test at the tarsal tunnel area. Ultrasonography and magnetic resonance imaging can reveal the space-occupying lesion, such as ganglion, lipoma, and neuroma. The initial treatments of tarsal tunnel syndrome are conservative management, such as physical therapy, night splint, and steroid injection. Surgical decompression is indicated after failure of conservative managements. Variable results of surgical treatment have been reported. Favorable result after decompression could be obtained from young patients, early onset symptoms, and space-occupying lesion.
Decompression ; Decompression, Surgical ; Diagnosis ; Foot ; Ganglion Cysts ; Humans ; Hypesthesia ; Lipoma ; Magnetic Resonance Imaging ; Neuroma ; Osteophyte ; Paresthesia ; Physical Examination ; Splints ; Tarsal Tunnel Syndrome* ; Tendons ; Tibial Arteries ; Tibial Nerve ; Ultrasonography ; Varicose Veins ; Veins