J Korean Foot Ankle Soc.  2018 Mar;22(1):44-47. 10.14193/jkfas.2018.22.1.44.

Tarsal Tunnel Syndrome Resulting from a Joint Originated the Intraneural Ganglion of the Medial Plantar Nerve: A Case Report: Surgical Treatment for Prevention of Recurrence

Affiliations
  • 1Department of Orthopedic Surgery, Kyung Hee University Hospital at Gangdong, Seoul, Korea.
  • 2Department of Orthopedic Surgery, Yeungnam University Hospital, Daegu, Korea. chpark77@naver.com

Abstract

There are a few reports on tarsal tunnel syndrome resulting from the intraneural ganglion. Although it can occur through a connection with the adjacent joint, there is no consensus on its pathogenesis and treatment method. This paper reports a case of tarsal tunnel syndrome resulting from the intraneural ganglion of the medial plantar nerve of the tibial nerve.

Keyword

Tarsal tunnel syndrome; Tibial nerve; Intraneural ganglion

MeSH Terms

Consensus
Ganglion Cysts*
Joints*
Methods
Recurrence*
Tarsal Tunnel Syndrome*
Tibial Nerve*

Figure

  • Figure 1 (A, B) Magnetic resonance images showed a 1.5×1.5-cm-sized cystic mass around the medial plantar nerve with homogeneous low signal intensity on the T1-weighted image and homogeneous high signal intensity on T2-weighted image. (C) Axial T2 image was suspected as an articular branch of intraneural ganglion connecting to the adjacent subtalar joint. Asterisk, medial plantar nerve intraneural ganglion.

  • Figure 2 The cystic mass was located in the epineurium of the medial plantar nerve.

  • Figure 3 The cystic mass was aspirated using a syringe, following the decompressed nerve was identified.

  • Figure 4 After the aspiration, as shown in the magnetic resonance images, cystic mass and its articular branch connecting to the adjacent subtalar joint were identified. Dashed line, decompressed medial plantar nerve; black arrowheads, articular branch.

  • Figure 5 Connection between cystic mass and adjacent subtalar joint was identified behind the sustentaculum tali (white arrowheads). Meticulous debridement of the involved joint capsule and flexor halluces tendon sheath was performed.

  • Figure 6 Photomicrograph of the resected lesion was diagnosed as a ganglion with the cyst wall consisted of the degenerative collagen fiber containing mucinous material (H&E stain, ×100).

  • Figure 7 At 18 months after surgery, no recurrence of ganglion was observed in medial plantar nerve on ultrasonography.


Reference

1. Ahmad M, Tsang K, Mackenney PJ, Adedapo AO. Tarsal tunnel syndrome: a literature review. Foot Ankle Surg. 2012; 18:149–152.
Article
2. Lau JT, Daniels TR. Tarsal tunnel syndrome: a review of the literature. Foot Ankle Int. 1999; 20:201–209.
Article
3. Sung KS, Park SJ. Short-term operative outcome of tarsal tunnel syndrome due to benign space-occupying lesions. Foot Ankle Int. 2009; 30:741–745.
Article
4. Spinner RJ, Desy NM, Rock MG, Amrami KK. Peroneal intraneural ganglia. Part I. Techniques for successful diagnosis and treatment. Neurosurg Focus. 2007; 22:E16.
5. Spinner RJ, Wang H. The first described joint-associated intraneural ganglion cyst. Neurosurgery. 2011; 69:1291–1298.
Article
6. Fujita I, Matsumoto K, Minami T, Kizaki T, Akisue T, Yamamoto T. Tarsal tunnel syndrome caused by epineural ganglion of the posterior tibial nerve: report of 2 cases and review of the literature. J Foot Ankle Surg. 2004; 43:185–190.
Article
7. Spinner RJ, Dellon AL, Rosson GD, Anderson SR, Amrami KK. Tibial intraneural ganglia in the tarsal tunnel: is there a joint connection? J Foot Ankle Surg. 2007; 46:27–31.
Article
8. Friedlander HL. Intraneural ganglion of the tibial nerve. A case report. J Bone Joint Surg Am. 1967; 49:519–522.
9. Spinner RJ, Atkinson JL, Harper CM Jr, Wenger DE. Recurrent intraneural ganglion cyst of the tibial nerve. Case report. J Neurosurg. 2000; 92:334–337.
10. Chick G, Alnot JY, Silbermann-Hoffman O. Benign solitary tumors of the peripheral nerves. Rev Chir Orthop Reparatrice Appar Mot. 2000; 86:825–834.
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