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MEDICINA E CHIRURGIA DELLA CAVIGLIA E DEL PIEDE
A Journal on Physiopathology and Surgery of the Foot
Indexed/Abstracted in: EMBASE, Scopus
Medicina e Chirurgia della Caviglia e del Piede 2015 April;39(1):1-8
The role of venous varicosity in the etiopathogenesis of the medial tarsal tunnel syndrome
Vittore D. 1, Caizzi G. 2, Abate A. 1, Arminio A. 1, Dilonardo M. 1, Bardelli M. 3
1 Dipartimento Medicina Clinica e Sperimentale, Università Degli Studi di Foggia, Struttura Complessa di Ortopedia e Traumatologia Universitaria, Ospedali Riuniti Foggia, Foggia, Italia;
2 Unità Operativa di Ortopedia e Traumatologia, Dipartimento di Scienze Mediche di Base, Neuroscienze e Organi di Senso, Università degli Studi di Bari “Aldo Moro”, Policlinico di Bari, Bari, Italia;
3 Santa Rita Hospital, Montecatini Terme, Pistoia, Italia
AIM: Tarsal tunnel syndrome belongs to the family of diseases so called canalicular syndromes. Those are characterized by a state of obstruction of the normal physiological course of the peripheral nerves, in general described as entrapment syndromes, where the content is to be somehow insulted by the containing. Various causes are recognized for this: traumatic, iatrogenic, abnormal static and dynamic of the hind foot, degenerative processes of tendons, joints and bones, systemic metabolic diseases. Cysts, lipomas, neurilemmomas, abnormalities of the abductor hallucis muscle are additional causes able to reduce normal available space into the tarsal tunnel. Varicose veins results from the loss of function of valves associated with impairment of the vessel walls; those can space just adjacent to the course of the posterior tibial nerve and their collapse can result in the tarsal tunnel syndrome of vascular nature. In our clinical and surgical experience we found that the peripheral venous varicosities are not a rare cause of tarsal tunnel syndrome, as demonstrated by the literature.
METHODS: In 2013 we treated surgically, three patients with tarsal tunnel syndrome with anamnestic history of venous insufficiency and ongoing pain associated with burning sensation at fingers and medial side of the hind foot. The diagnostic process is based on two fundamental levels: physical examination with anamnestic history positive for peripheral venous insufficiency; the instrumental contribution, ultrasound and Doppler ultrasound.
RESULTS AND CONCLUSION: Magnetic resonance imaging provides more accurate anatomical images, factually recognized by the surgeon during the release procedure.