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Proximal Tibial Nerve Compression: Results of Surgical Decompression
Eric H. Williams, MD; Gedge D. Rosson, MD; Robert Hagan, MD; S. Shar Hashemi, MD; A. Lee Dellon, MD, PhD
Johns Hopkins, Baltimore, MD, USA
Proximal tibial nerve (PTN) compression remains a rarely recognized clinical condition. It has been described in cadavers, in cohort of 3 patients with co-existing common peroneal nerve compression, and MRI findings have been reported. The purpose of this study is to describe the technique of decompression of the tibial nerve in the calf and to report the clinical outcomes of fourty-nine patients with Soleal Sling Syndrome.
METHODS:
The proximal tibial nerve was decompressed in the calf by dividing the most proximal fascia of the soleal fibromuscular sling through a medial calf approach. Forty-nine patients were stratified retrospectively into three groups. NEUROPATHY GROUP: 10 patients. FAILED TARSAL TUNNEL SYNDROME GROUP: 25 patients; and TRAUMA GROUP: 14 patients. Outcomes evaluated were pain level (Likert Scale 0-10), strength of the flexor hallucis longus (FHL), neurosensory testing of the hallux, and subjective sensory improvement. Results were graded as excellent, good, fair, and poor based on drop in pain levels, improvement in motor function, two-point discrimination of the hallux, and patient’s subjective report of sensory improvement.
RESULTS:
NEUROPATHY GROUP: 75% of patients (6 of 8) had relief of pain. (Likert dropping from 7.38 to 3.38 p = 0.006). FAILED TARSAL TUNNEL SYNDROME GROUP: 66.7% of patients (14 of 21) had relief of pain (Likert dropping from 5.71 to 3.52 p < 0.001). TRAUMA GROUP: 92.9% of patients (13 of 14) had relief of pain (Likert dropping from 8.93 to 2.43 p < 0.001).
The results for number of patients with improvement in motor function of the FHL, improvement of 2 mm in 2 point discrimination, and of subjective sensory improvement are presented in Table 1.
Overall outcome for each group of patients is presented in Table 2.
CONCLUSION:
Regardless of etiology, if PTN compression beneath the soleal sling is identified, neurolysis may improve pain, sensory, and motor function. Excellent results may be found in 64% of post-traumatic patients.
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