Tarsal tunnel decompression (for tarsal tunnel syndrome) surgical technique
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Tarsal tunnel syndrome classically presents with neurological symptoms effecting the sole of the foot in the distribution of one or both terminal branches of the posterior tibial nerve. Classically the symptoms are worse at night and only the sole of the foot is effected. It may though produce symptoms anytime and sometimes daytime symptoms are the more prevalent. Other than the classical distribution of symptoms the other standout feature is usually the severity of the pain which can be very significant.
Most commonly it is due to tight fascial layers or peri-neural fibrosis compressing the posterior tibial nerve and its branches though extrinsic compression from ganglions and other space occupying lesions can less commonly cause the condition.
Nerve conduction testing is diagnostic in two thirds or so of and physical examination is more often equivocal or unrevealing. Often the strongest indication of the diagnosis is the history. Lumbar spine and more general nerve pathology should be excluded but the possibilty of a “double crush” phenomenon should always be borne in mind.
Surgical treatment if performed with rigorous attention to detail is highly successful in my experience and warranted in symptomatic cases irrespective of their chronicity. Pain is most consistently dealt with by the Tarsal tunnel release and is also the earliest feature expected to improve, though sensory improvement is also to be expected.
Author: Mark Herron FRCS
Institution: The Wellington Hospital, London,UK.
- Each operation and the questions associated become a named course in the CPD section
- The operative technique itself is read as a lesson as is any company implant information if this is being assessed.
- You’ll need to tick the box to confirm this has been done and can do this immediately if you have already read the op tech.
- The vast majority of operations have a 10-15 MCQ quiz covering all aspects of the decision making and the technique
- There are four possible answers of which one is correct (or on occasion more correct) than the others.
- There are additional quiz modules on the surgical steps, the implants and problem cases being added continually
- The course is completed once all the lessons are read and quizzes submitted and passed.
- On successful completion of each quiz you will receive validated CPD points that add to the certificate in your CPD folder.
- Your dashboard also will contain a record of the time you have spent logged onto and using the site.
- The timer suspends after 5 minutes though if there is no activity.
- When you restart you will resume at the same point in the module.
- Once you have completed each quiz you will need to feedback on the module first then click “submit” and your paper will be marked.
The pass mark is 75%.
- If you fall below this level you will be directed back to re-read the slides where you’ve tripped up.
- Once these have been read you can re-do just the questions you failed on.
- Once you have passed the quiz you can return at a future stage & resit .
- Operation Quiz – 1 CPD point
- Surgical steps Quiz – 1/4 CPD point
- Implants Quiz – 1/4 CPD point
- Problem case Quiz – 1/2 CPD point
One CPD point equates to one hour of academic activity
Welcome to the Professional Development question section. The objective of taking these tests is to demonstrate that you have understood all aspects of the assessment and management of patients requiring surgical intevention. On successful completion you will receive a certificate accredited by both the Royal College of Surgeons of both England and Edinburgh as well as the British Orthopaedic Association.
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