The natural history of tarsal tunnel syndrome in diabetic subjects

Willem D. Rinkel*, Manuel Castro Cabezas, Erwin Birnie, J. Henk Coert

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

INTRODUCTION: Tibial nerve entrapment is highly prevalent in diabetic subjects, resulting in significantly more neuropathic complaints and concomitant sensory disturbances. The study aim was to assess the impact of tarsal tunnel syndrome (TTS) and sensory loss at baseline on incident diabetic foot ulceration (DFU) in diabetic patients, since decompressing the tibial nerve might change the natural history of the disease.

METHODS: In this study, 113 subjects with TTS (69 bilateral, 23 left-sided and 21 right-sided) participating in the prospective Rotterdam Diabetic Foot Study were compared to 303 diabetic controls without TTS, regarding incident DFU. Kaplan-Meier analysis and Cox's regression analysis were used to determine the independent hazard of baseline variables for new DFU.

RESULTS: The median observation period was 836.5 days (IQR, 459-1077.8). In bilateral TTS, 17.4% (95% CI: 8.4-26.3%) of subjects experienced DFU versus 8.3% (95% CI: 5.1-11.6%) in controls (left or right) during follow-up (p = 0.0036). In left-sided TTS, no subjects versus 6.2% (95% CI: 3.4-9.0%) in controls had DFUs (p = 0.243). Incident ulceration was seen in 14.3% (95% CI: -0.7% to -29.3%) of right-sided TTS subjects versus 4.1% (95% CI: 1.5-6.3%) in controls (p = 0.034). Besides HbA1c, diminished sensation at the hallux independently increased the risk of ulceration, in patients with (HR: 4.692, p = 0.003) and without (HR: 2.307, p = 0.002) prior DFU.

DISCUSSION: Elevated sensory thresholds in TTS render diabetic patients at a higher risk for DFU. With effective surgery, TTS is likely to be an amenable factor to potentially prevent diabetic foot disease and thereby reduce amputation risk.

LEVEL OF EVIDENCE: II.

Original languageEnglish
Pages (from-to)1482-1489
Number of pages8
JournalJournal of Plastic Reconstructive and Aesthetic Surgery
Volume73
Issue number8
DOIs
Publication statusPublished - Aug-2020

Keywords

  • Tarsal tunnel syndrome
  • Tibial nerve entrapnient
  • Neuropathy
  • Loss of sensation
  • Diabetic foot ulceration
  • FOOT ULCERATION
  • SURGICAL DECOMPRESSION
  • NERVE DECOMPRESSION
  • LOWER-EXTREMITY
  • PERIPHERAL-NERVES
  • TIBIAL NERVE
  • PAIN RELIEF
  • TINEL SIGN
  • NEUROPATHY
  • COMPRESSION

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