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
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Article info
Publication history
Published online: September 12, 2011
Footnotes
Financial Disclosure: This research study was funded by GraMedica, LLC (Macomb, MI).
Conflict of Interest: Michael E. Graham is the inventor of HyProCure®. He is the Founder and President of GraMedica, LLC., the company that manufactures and distributes HyProCure®. He is also the Founder of Graham International Implant Institute.
Identification
Copyright
© 2011 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.
