Advertisement

Effect of Extra-osseous Talotarsal Stabilization on Posterior Tibial Nerve Strain in Hyperpronating Feet: A Cadaveric Evaluation

Published:September 12, 2011DOI:https://doi.org/10.1053/j.jfas.2011.07.004

      Abstract

      Excessive abnormal strain or tension on the posterior tibial nerve in feet exhibiting talotarsal instability has been considered one of the possible etiologic factors of tarsal tunnel syndrome. The suggested treatment options in such cases include stabilization of the talotarsal joint complex in a corrected position, which might help minimize the abnormal forces placed on the posterior tibial nerve due to over stretching. The primary goal of this study was to quantify strain on the posterior tibial nerve in feet exhibiting hyperpronation caused by talotarsal instability, before and after an extra-osseous talotarsal stabilization (EOTTS) procedure. We hypothesized that the excessive strain placed on the posterior tibial nerve in hyperpronating cadaveric feet would be reduced significantly after intervention using the HyProCure® EOTTS device. Posterior tibial nerve strain was quantified in 9 fresh-frozen cadaver specimens. A miniature differential variable reluctance transducer was used to measure nerve elongation as the foot was moved from its neutral to a maximally pronated position, before and after intervention. The mean elongation of the posterior tibial nerve (with respect to a fixed reference point) decreased by 43% after the EOTTS procedure (i.e., from 5.91 ± 0.91 mm to 3.38 ± 1.20 mm; N = 27). The reduction was statistically significant at p < .001. HyProCure® was effective in stabilizing the talotarsal joint complex, thus reducing the excessive amount of strain placed on the posterior tibial nerve. Clinical implications of this study suggest the use of EOTTS devices in the treatment of tarsal tunnel syndrome.

      Level of Clinical Evidence

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The Journal of Foot and Ankle Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Keck C.
        The tarsal-tunnel syndrome.
        J Bone Joint Surg Am. 1962; 44: 180-182
        • Kopell H.P.
        • Thompson W.A.
        Peripheral entrapment neuropathies of the lower extremity.
        N Engl J Med. 1960; 262: 56-60
        • Lam S.J.
        A tarsal-tunnel syndrome.
        Lancet. 1962; 2: 1354-1355
        • Cimino W.R.
        Tarsal tunnel syndrome: review of the literature.
        Foot Ankle Int. 1990; 11: 47-52
        • Kuper B.C.
        Tarsal tunnel syndrome.
        Orthop Nurs. 1998; 17: 9-15
        • Lau J.T.C.
        • Daniels T.R.
        Tarsal tunnel syndrome: a review of the literature.
        Foot Ankle Int. 1999; 20: 201-209
        • Daniels T.R.
        • Lau J.T.
        • Hearn T.C.
        The effects of foot position and load on tibial nerve tension.
        Foot Ankle Int. 1998; 19: 73-78
        • Lau J.T.C.
        • Daniels T.R.
        Effects of tarsal tunnel release and stabilization procedures on tibial nerve tension in a surgically created pes planus foot.
        Foot Ankle Int. 1998; 19: 770-777
        • Rempel D.
        • Dahlin L.
        • Lundborg G.
        Pathophysiology of nerve compression syndromes: response of peripheral nerves to loading.
        J Bone Joint Surg Am. 1999; 81: 1600-1610
        • Lundborg G.
        • Rydevik B.
        Effects of stretching the tibial nerve of the rabbit: a preliminary study of the intraneural circulation and the barrier function of the perineurium.
        J Bone Joint Surg Br. 1973; 55: 390-401
        • Wall E.J.
        • Massie J.B.
        • Kwan M.K.
        • Rydevik B.L.
        • Myers R.R.
        • Garfin S.R.
        Experimental stretch neuropathy: changes in nerve conduction under tension.
        J Bone Joint Surg Br. 1992; 74: 126-129
        • Kwan M.K.
        • Wall E.J.
        • Massie J.
        • Garfin S.R.
        Strain, stress and stretch of peripheral nerve rabbit experiments in vitro and in vivo.
        Acta Orthop. 1992; 63: 267-272
        • Francis H.
        • March L.
        • Terenty T.
        • Webb J.
        Benign joint hypermobility with neuropathy: documentation and mechanism of tarsal tunnel syndrome.
        J Rheumatol. 1987; 14: 577-581
        • Graham M.E.
        • Jawrani N.T.
        • Goel V.K.
        The effect of HyProCure® sinus tarsi stent on tarsal tunnel compartment pressures in hyperpronating feet.
        J Foot Ankle Surg. 2011; 50: 44-49
        • Husain Z.S.
        • Fallat L.M.
        Biomechanical analysis of Maxwell-Brancheau arthroereisis implants.
        J Foot Ankle Surg. 2002; 41: 352-358
        • Maxwell J.R.
        • Carro A.
        • Sun C.
        Use of the Maxwell-Brancheau arthroereisis implant for the correction of posterior tibial tendon dysfunction.
        Clin Podiatr Med Surg. 1999; 16: 479-489
        • Viladot R.
        • Pons M.
        • Alvarez F.
        • Omaña J.
        Subtalar arthroereisis for posterior tibial tendon dysfunction: a preliminary report.
        Foot Ankle Int. 2003; 24: 600-606
        • Schon L.C.
        Subtalar arthroereisis: a new exploration of an old concept.
        Foot Ankle Clin. 2007; 12: 329-339
        • Zaret D.I.
        • Myerson M.S.
        Arthroereisis of the subtalar joint.
        Foot Ankle Clin North Am. 2003; 8: 605-617
        • Needleman R.L.
        A surgical approach for flexible flatfeet in adults including a subtalar arthroereisis with the MBA sinus tarsi implant.
        Foot Ankle Int. 2006; 27: 9-18
        • Gould N.
        Evaluation of hyperpronation and pes planus in adults.
        Clin Orthop Relat Res. 1983; 181: 37-45
        • Hammer W.I.
        Hyperpronation: causes and effects.
        Chiro Sports Med. 1992; 6: 97-101
        • Graham M.E.
        Hyperpronation—the role of subtalar arthroereisis.
        Eur Musculoskel Rev. 2010; 5: 65-69
        • Stovitz S.D.
        • Coetzee J.C.
        Hyperpronation and foot pain: steps towards pain-free feet.
        Phys Sports Med. 2004; 32: 19-26
        • Rydevik B.L.
        • Kwan M.K.
        • Myers R.R.
        • Brown R.A.
        • Triggs K.J.
        • Woo S.L.
        • Garfin S.R.
        An in vitro mechanical and histological study of acute stretching on rabbit tibial nerve.
        J Orthop Res. 1990; 8: 694-701
        • Rydevik B.L.
        • Lundborg G.
        • Bagge U.
        Effects of graded compression on intraneural blood flow: an in vivo study on rabbit tibial nerve.
        J Hand Surg Am. 1981; 6: 3-12
        • Edwards W.G.
        • Lincoln C.R.
        • Bassett F.H.I.
        • Goldner J.L.
        The tarsal tunnel syndrome: diagnosis and treatment.
        JAMA. 1969; 207: 716-720
        • Alshami A.M.
        • Babri A.S.
        • Souvlis T.
        • Coppieters M.W.
        Biomechanical evaluation of two clinical tests for plantar heel pain: the dorsiflexion-eversion test for tarsal tunnel syndrome and the windlass test for plantar fasciitis.
        Foot Ankle Int. 2007; 28: 499-505
        • Alshami A.M.
        • Babri A.S.
        • Souvlis T.
        • Coppieters M.W.
        Strain in the tibial and plantar nerves with foot and ankle movements and the influence of adjacent joint positions.
        J Appl Biomech. 2008; 24: 368-376
        • Coppieters M.W.
        • Alshami A.M.
        • Babri A.S.
        • Souvlis T.
        • Kippers V.
        • Hodges P.W.
        Strain and excursion of the sciatic, tibial, and plantar nerves during a modified straight leg raising test.
        J Orthop Res. 2006; 24: 1883-1889
        • Wright T.W.
        • Glowczewskie F.
        • Wheeler D.
        • Miller G.
        • Cowin D.
        Excursion and strain of the median nerve.
        J Bone Joint Surg Am. 1996; 78: 1897-1903