Conor O�Brien, R Byrden and P Moroney
Sports Surgery Clinic, Ireland
Posters & Accepted Abstracts: J Neurol Neurophysiol
Tarsal Tunnel syndrome is the most common lower limb focal neuropathy. The pick-up rate is low with most Electrodiagnostic laboratories reporting 0.55% of all cases seen. This is probably due to a non-standard methodology in assessing this condition and a failure to take into account the complex nature of the nerve at the level of the tarsal tunnel. The tibial nerve has 4 main branches, 9 different branching patterns. This study assessed the tibial nerve and evaluated 12 different parameters thus increasing significantly the diagnostic yield and electrodiagnostic sensitivity. Pick up rate doing full assessment was significantly increased. Our study had a pick up rate of over 3% (41 positive cases out of a 1200 patient referral in a calendar year). Significant findings of over 80% of positive cases had either prior injury or surgery to affected lower limb. The Calcaneal sensory study and the needle EMG to the distal H and ADQ muscles were the most sensitive tests. These 3 tests are not routinely performed in most labs. These findings: knowledge of the anatomy has improved hence performing the standard Motor test to the AH muscle and the Medial Plantar sensory study only will significantly reduce the diagnostic yield, hence a complete assessment has to be performed to cater for the variable anatomy. The confirmation of the diagnosis is often based in the literature on successful surgery which is flawed as the results are poor [48-70% success rate]. This study suggests that this 12 parameter assessment becomes the standard assessment for TTS.
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