PAIN SYNDROMES OF THE TIBIAL NERVE AT THE TRANSITION BETWEEN LOWER LEG AND FOOT

The prognosis of surgical treatment of the tarsal tunnel syndrome (TTS) with regard to total pain relief is worse than following surgery of the carpal tunnel syndrome. In TTS, additional static factors play a role. The indication for surgery, therefore, is made with utmost reluctance. The surgical strategy is described extensively. In the majority of patients a considerable improvement of symptoms can be achieved. There are, however, individual patients in whom surgical intervention is followed by increased pain. Three such patients are reported. This pain syndrome is caused and increased by recurrent fibrosis of the nerve bed, eventually including the integument and inducing entrapment neuropathy by the contracted dermal covering. Surgical resolution of this problem is transplantation of soft tissues to surround the nerve and skin grafting to augment the covering dermal layer.