What are the other Names for the Procedure?
- Repair of Tarsal Tunnel Syndrome
- Surgery for Tarsal Tunnel Syndrome
- Tarsal Tunnel Syndrome Repair
What is Tarsal Tunnel Syndrome Release surgical procedure?
- The nerve, responsible for feeling and sensation in the ankle and foot, is called the tibial nerve. It passes through a narrow passage, called the tarsal tunnel, made of tarsal ligaments and surrounding bone and tissue in the ankle
- The tibial nerve may get compressed in the event of an injury to the ankle due to swelling of the ligaments, or for any other reason, which leads to pain and numbness in the ankle. This is known as tarsal tunnel syndrome. This can occur either on one ankle, or on both the ankles
- A Tarsal Tunnel Syndrome Release involves the cutting of the laciniate ligament (a strong fibrous band in the foot) and tarsal muscles that cause compression of the tibial nerve. The symptoms usually get better after the surgery
What part of the Body does the Procedure involve?
The Tarsal Tunnel Syndrome Release procedure involves the:
- Ankle joint
- The tibial nerve
- Laciniate ligament
- Surrounding connective and fibrous tissue
Why is the Tarsal Tunnel Syndrome Release surgical procedure Performed?
The Tarsal Tunnel Syndrome Release surgery is performed to relieve pain and numbness in the ankle, caused as a result of the tibial nerve being compressed by the surrounding tissue and ligaments.
What are some Alternative Choices for the Procedure?
Oral medications, physical therapy, and steroid injections into the tarsal tunnel regions are alternatives to the procedure. However, if the symptoms last for over 6 months, then a Tarsal Tunnel Syndrome Release surgery is considered as the gold-standard procedure.
What are the Recent Advances in the Procedure?
Recent advances to the procedures are in the use of minimally-invasive techniques (key-hole tarsal tunnel surgery).
What is the Cost of performing the Tarsal Tunnel Syndrome Release surgical procedure?
The cost of Tarsal Tunnel Syndrome Release surgical procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers, and healthcare facilities.
In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.
When do you need a Second Opinion, prior to the Procedure?
- It is normal for a patient to feel uncomfortable and confused with a sudden inflow of information regarding Tarsal Tunnel Syndrome Release surgical procedure and what needs to be done
- If the patient needs further reassurance or a second opinion, a physician will almost always assist in recommending another physician
- Also, if the procedure involves multiple surgeries or has many alternatives, the patient may take a second opinion to understand and choose the best one. They can also choose to approach another physician independently
What are some Helpful Resources?
http://www.foot-specialist.com/tarsal-tunnel-repair.htm (accessed on May 26, 2015)
https://www.kaahe.org/health/en/15401-tarsal-tunnel-release/all.html (accessed on May 26, 2015)
Prior to Tarsal Tunnel Syndrome Release surgical procedure:
How is the Tarsal Tunnel Syndrome Release surgical procedure Performed?
- Immediately before starting the Tarsal Tunnel Syndrome Release surgery, the surgeon puts a compression band just above the ankle to prevent excessive bleeding
- Next, an incision is made along the nerve in the back of the ankle. The laciniate ligament is isolated and severed to release pressure on the tibial nerve
- Next, the surgeon closes the wound with sutures and applies a bandage
Where is the Procedure Performed?
The Tarsal Tunnel Syndrome Release procedure is performed in a hospital or outpatient facility. The patient gets admitted (usually on an outpatient basis), undergoes the procedure, and is discharged, as per the instruction of the physician.
Who Performs the Procedure?
The Tarsal Tunnel Syndrome Release procedure is performed either by an orthopedic surgeon, or a general surgeon, along with an anesthesiologist.
How long will the Procedure take?
The procedure may take anywhere between 30-60 minutes.
What do you need to tell your Physician before the Procedure?
It is very important to provide the following information to your healthcare provider. This enables your healthcare provider in assessing the risks for the Tarsal Tunnel Syndrome Release surgical procedure and helps avoid unnecessary complications.
- Provide a complete list of medications you are currently taking to your physician. This information is useful for a variety of reasons. For example, it can help your healthcare provider prevent complications due to a drug interaction
- If you are allergic to any specific medication or food items
- If you are taking blood thinners such as aspirin, warfarin, herbal supplements, or any other such medications
- If you or your family members have a history of bleeding disorders or if there is a tendency to bleed more than normal
- If you have diabetes, high blood pressure, chest pains, or have previously suffered from a heart attack
- If you have ever been diagnosed with blood clots in your leg (deep vein thrombosis) or lung (embolism of lung)
- If you have a history of frequent bone fractures (this may affect bone-healing, if bones are involved as part of your procedure)
- A list of all previous surgical procedures you have undergone, for example: Removal of appendix, gallbladder, or any other part of your body; surgical repair of any body part ,such as hernia repair, perforation of bowel wall, etc.
What Preparations are needed, prior to the Procedure?
- The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient including information related to the medications that are being currently taken
- Some medications increase a person’s chances of bleeding and it may be recommended to discontinue them for a period of time before the procedure is performed
- Blood tests may be performed to determine if there is a bleeding tendency or any other medical conditions that prevents the person from undergoing the procedure
- Do inform the physician if you are allergic to any local anesthetics, lidocaine, etc.
- Avoid application of any cosmetics, deodorant, or topical medicines on the area, prior to the procedure
- It is advisable to quit smoking and the use of any nicotine based products for a while, before the surgery
- Consumption of alcoholic drinks must also be avoided for a period of time, as instructed
- The patient must avoid eating or drinking at least 8 hours prior to the surgical procedure, depending on when the procedure is arranged
- For persons suffering from diabetes, it is important that the blood sugar stays within the normal range; if not their diabetologist may have to control blood sugar by recommending insulin and/or a combination of oral medicines
What is the Consent Process before the Procedure?
A physician will request your consent for Tarsal Tunnel Syndrome Release procedure using an Informed Consent Form.
Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.
You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.
What Tests are needed, before the Tarsal Tunnel Syndrome Release surgical procedure?
Before the Tarsal Tunnel Syndrome Release procedure, the following tests may be recommended:
- Routine blood and urine analysis
- X-ray of the ankle
- Electromyography (EMG)
- Nerve conduction test
- The physician may suggest further tests depending on the health of the patient and their medical history.
What are some Questions for your Physician?
Some of the basic questions that you might ask your physician are as follows:
- What is a Tarsal Tunnel Syndrome Release procedure?
- What exactly does the surgery involve?
- Why is this procedure necessary?
- What does the procedure involve?
- How will this procedure help?
- Will I be able to move my ankle freely after the procedure?
- How soon should I get it done? Is there an emergency?
- Who are the medical personnel involved in this procedure?
- Where is the procedure performed?
- What are the risks while performing the procedure?
- What are the complications that might take place, during recovery?
- How long will it take to recover? When can I resume normal work?
- Are there any lifestyle restrictions or modifications required, after the procedure is performed?
- How many such procedures have you (the physician) performed?
- Are there any follow-up tests, periodic visits to the healthcare facility required, after the procedure?
- What are the costs involved?
During the Tarsal Tunnel Syndrome Release surgical procedure:
What kind of Anesthesia is given, during the Procedure?
- During the procedure the patient is administered regional anesthesia, either with or without sedation
- However, in some cases, general anesthesia may be administered. When general anesthesia is necessary, the procedure is usually performed at a hospital surgery facility
How much Blood will you lose, during the Procedure?
The amount of blood lost during the procedure is generally minimal; but, this may vary from one individual to another.
What are the possible Risks and Complications during the Tarsal Tunnel Syndrome Release surgical procedure?
There are general factors that increase the risk of getting complications during Tarsal Tunnel Syndrome Release surgery and they include:
- Obesity: Generally greater the degree of obesity, greater is the surgical risk
- Smoking: Longer the smoking history (in pack years smoked), greater the surgical risk
- Advancing age
- Poorly controlled diabetes, as evidenced by a high hemoglobin A1c and a high fasting glucose
- Poorly functioning kidney, as evidenced by increased BUN (blood urea nitrogen) and blood creatinine
- Poorly functioning liver, as evidenced by increased blood liver function tests
- Hypertension (increased blood pressure), especially if it is poorly controlled
- Poor nutritional status (malnutrition with mineral and vitamin deficiencies)
- Poor lung function, as evidenced by abnormal lung function tests
- History of bleeding disorders
- Longstanding illness, such as autoimmune disorders, chronic infections
- Poor immune system due to a variety of causes
The possible risks or complications that may arise during the surgery are:
- Excessive bleeding
- Accidental injury to the neighboring tissue or bone
- Anesthetic complications
What Post-Operative Care is needed at the Healthcare Facility after the Tarsal Tunnel Syndrome Release surgical procedure?
At the healthcare facility, generally there is no requirement for any post-procedure care, unless any complications arise.
After the Tarsal Tunnel Syndrome Release surgical procedure:
What are the possible Risks and Complications after the Tarsal Tunnel Syndrome Release surgical procedure?
Post Tarsal Tunnel Syndrome Release procedure, the following complications may arise:
- Surgical wound infection
- Continued pain and numbness in the ankle or foot
What is the Prognosis after the Surgery?
- The prognosis of the surgical procedure is usually excellent; a full recovery from tarsal tunnel syndrome is expected
- Almost immediately after the surgery, the patient may experience relief from the symptoms such as pain and numbness
When do you need to call your Physician?
Do contact your physician if you notice any of the following symptoms:
- Pain around the surgical wound
- Swelling and redness
- Bleeding or drainage
- Muscle ache
- Signs of infection
- If any new symptom or discomfort is observed
What Post-Operative Care is needed at Home after the Tarsal Tunnel Syndrome Release surgical procedure?
At home, the following post-operative care is recommended, after a Tarsal Tunnel Syndrome Release procedure:
- Use a soft and clean cloth to press the wound and wipe it, if bleeding occurs on the first day after surgery
- Use warm compress band to relieve surgical pain
- Keep the wound clean and dry
- Wash the wound with a mild soap while bathing
- Try exercising your ankle to avoid stiffness
- Regularly change bandages as directed by the physician
- Avoid taking non-prescribed medications
- Slowly resume regular/daily activities, as advised by the surgeon and physical therapist, to aid in a faster recovery
How long does it normally take to fully recover, from the Procedure?
It takes about two months to completely recover from the Tarsal Tunnel Syndrome Release procedure.
What happens to tissue (if any), taken out during the Procedure?
The tissue is taken for further examination and later disposed, as per the standard medical procedure.
When should you expect results from the pathologist regarding tissue taken out, during the Procedure?
- The tissue removed is processed in the laboratory under a pathologist's supervision
- The slide(s) are prepared once the tissue is processed, and this is examined by a pathologist and a pathology report issued
- Depending on the complexity of the case, issue of the report may take anywhere between 72 hours to a week's time
Who will you receive a Bill from, after the Tarsal Tunnel Syndrome Release surgical procedure?
It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers.
Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:
- The outpatient facility or hospital
- An orthopedic surgeon or general surgeon
- An anesthesiologist (if anesthesia was administered)
- A pathologist
Individuals are advised to inquire and confirm the type of billing, before the Tarsal Tunnel Syndrome Release surgical procedure is performed.
Thanks and Gratitude:
We sincerely acknowledge and thank Dr. Douglas J. Jones for reviewing the article. His valuable input and feedback has helped enrich the contents of this article.
Douglas J. Jones, MD FACS
Board Certified General Surgeon and Faculty Member
University of Illinois, College of Medicine at Urbana-Champaign
506 S. Mathews Ave., Urbana, IL 61801, USA