Hernández GEH, Pérez SG, Mosquera BG

Language: Spanish
References: 10
Page: 745-754
PDF size: 241.06 Kb.

ABSTRACT

Background: the syndrome of the tarsal tunnel is a neuropathy caused by trapping the posterior tibial nerve and its branches in the flexor retinaculum. The diagnosis can be difficult and the surgical treatment is indicated for most of the patients.
Objective: to present a case of syndrome of the tarsal tunnel caused by an epineural ganglion and to familiarize the medical staff with this infrequent cause of pain and paresthesia in the foot.
Clinical Case: a fiftyoneyearold female patient comes to the consultation because of a rise in volume and pain in the posteroinferior area of the left tibial malleolus, associate to paresthesia radiated to the plantar region. In the physical examination, a threecm fluctuating single tumor that was fixed to deep planes and painful on percussion was confirmed. The ultrasonography of soft parts showed an image of cystic aspect of 26 x 14.8 mm with welldefined margins and fine walls, partitioned and closely related to the posterior tibial nerve. The initial treatment was conservative but the patient did not get better; that is why a definitive surgical treatment that consisted in the exeresis of the cystic lesion was chosen with the objective of reducing pain and paresthesia.
Conclusion: the syndrome of the tarsal tunnel caused by an epineural ganglion is considered an infrequent diagnosis; that is why any lesion of a cystic consistency that occupies the tarsal tunnel can make think on the diagnosis. The surgical treatment is safe and effective solving the clinical manifestations with a minimal of complications.

REFERENCES

1. Ürgüden M, Bilbas H, Özdemir H, Söyüncü Y, Gür S, Aydin AT. Tarsal tunnel syndromethe effect of the associated features on outcome of surgery. Int Orthop (SICOT). 2002;26(4):253–6.

2. Antoniadis G, Scheglmann K. Posterior Tarsal Tunnel Syndrome. Diagnosis and Treatment. Dtsch Arztebl Int [Internet]. 2008 Nov [citado 6 Jul 2013];105(45):[aprox. 5 p.]. Disponible en:http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2697008 /

3. Dong Q, Jacobson JA, Jamadar DA, Gandikota G, Brandon K, Morag Y, et al. Entrapment Neuropathies in the Upper and Lower Limbs: Anatomy and MRI Features. Radiol Res Pract [Internet]. 2012 Oct [citado 6 Jul 2013];2012(2012):[aprox. 12 p.]. Disponible en:http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3483739/

4. Hudes K. Conservative management of a case of tarsal tunnel syndrome. J Can Chiropr Assoc. 2010;54(2):1006.

5. Ahn JH, Choy WS, Kim HY. Operative treatment for ganglion cysts of the foot and ankle. J Foot Ankle Surg [Internet]. 2010 SepOct [citado 6 Jul 2013];49(5):[aprox. 3 p.]. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/20650661

6. Cione JA, Cozzarelli J, Mullin CJ, Dellon AL. Tarsal tunnel surgery secondary to a tarsal ganglion: be prepared before performing this complicated operation. Foot Ankle Spec [Internet]. 2009 Feb [citado 6 Jul 2013];2(1):[aprox. 5 p.]. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/19825749

7. Fujita I, Matsumoto K, Minami T, Kizaki T, Akisue T, Yamamoto T. Tarsal tunnel syndrome caused by epineural ganglion of the posterior tibial nerve: report of 2 cases and review of the literature. J Foot Ankle Surg. 2004 MayJun;43( 3):18590.

8. Subhawong TK, Wang KC, Thawait SK, Williams EH, Hashemi SS, Antonio J. Machado, et al. High resolution imaging of tunnels by magnetic resonance neurography. Skeletal Radiol [Internet]. 2012 Jan [citado 6 Jul 2013];41(1):[aprox. 6 p.]. Disponible en: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3158963/

9. Samaras D. Tarsal tunnel syndrome caused by a flexor digitorum accessorius longus muscle: a case report and review of the literature. J Foot Ankle Res. 2011;4(1):O42.

10. Gould JS. The failed tarsal tunnel release. Foot Ankle Clin. 2011 Jun;16(2):28793.