SLR - May 2020 - Howard C. Chang
References: Viswanathan M, Lakshmanan S, Anbazhagan R, Tarsal Tunnel Decompression: An Effective Method for Prevention of Foot Complications in Diabetic Patients with Compressive Neuropathy at Tarsal Tunnel. Int Surg J. 2018 Nov; 5(11):3520-26Scientific Literature Review
Reviewed By: Howard C. Chang, DPM
Residency Program: Regions/HealthPartners Institute – St. Paul, MN
Podiatric Relevance: Diabetic neuropathy is a common accompanying factor in approximately 90 percent of diabetic foot ulceration. Patients with peripheral neuropathy with loss of protective sensation sustain repetitive trauma unknowingly, which may result in foot complications. Foot ulcers precede approximately 80 percent of diabetic lower limb amputations. This study aims to identify the efficiency of tarsal tunnel decompression of an entrapped tibial nerve in diabetic patients, in ulcer healing and in the prevention of development of new diabetic related foot complications.
Methods: Seventy patients at one institution were randomly selected. Study population included diabetics who had a solitary plantar ulceration in one foot (test limb) of Wagner grade one and two, <3 centimeters and have a non-ulcer contralateral limb to act as control. Tarsal tunnel release was performed on the affected limb. Ulcer dimension and rate of healing was recorded. Any new foot changes were also documented for both extremities.
Results: Following tarsal tunnel release, 65/70 noted sensory gains via semms-weinstein monofilament test. 69/70 were documented to have resolution of Tinel’s sign. At six weeks all patient’s had a reduction in wound size. At three months, 90.48 percent of the ulcers present showed complete healing. In regards to new foot changes, only two new changes were noted on the test limb compared to 15 in the control limb. This was noted to be statistically significant (p<0.05)
Conclusions: The authors concluded that tarsal tunnel release does serve a role in ulcer progression as well as a prophylactic role in preventing new foot wounds. In their sample population, a majority of the wounds were completely healed at three months status post tarsal tunnel release. Additionally, the test limbs that had underwent tarsal tunnel release had lower rates of developing new wounds compared to the contralateral side. Their results yield similar results to prior studies evaluating the role of tarsal tunnel release in diabetic wounds with peripheral neuropathy. The authors had strict exclusion criteria for ABI and comorbidities including cardiac, renal, and immunosuppression. Unfortunately, many diabetic patients are also concurrently afflicted by vascular insufficiency and renal compromise and a limitation of these results may be its lack of generalizability to the majority of the diabetic population. I did find this paper promising in detailing the prophylactic role of tarsal tunnel release for diabetic wound healing. To my knowledge, tarsal tunnel releases is not routinely performed for wound healing and perhaps should be a prophylactic procedure offered to diabetics with associated neuropathy to prevent ulceration.