Tibial nerve decompression: Reliable exposure using shorter incisions

Background: Patients and surgeons recognize the value of procedures that minimize scarring and tissue dissection, but technical standards do not exist with regards to incision lengths needed for tibial nerve decompression. This article introduces reproducible techniques that reliably provide exposure for release of known anatomical compression points of the tibial nerve, while minimizing the length of required skin incisions. Methods: The senior author's approach to decompression of the tibial nerve at the soleus arch and the tarsal tunnel is presented. Typical incision lengths and surgical exposure are demonstrated photographically. The safety of using this technique is examined by review of the medical records of all patients undergoing this procedure from 2003 to 2011, looking for technical complications such as unintentional damage to nerves or adjacent structures. Results: 224 consecutive patients undergoing 252 total procedures underwent release of known anatomical compression points of the tibial nerve at either the tarsal tunnel, inner ankle, or the soleus arch. Typical incision lengths used for these procedures were 5 cm for the proximal calf and 4.5 cm for the tarsal tunnel. Review of medical records revealed no incidences of unintentional injury to nerves or adjacent important structures. Functional and neurological outcomes were not assessed. Conclusions: Tibial nerve decompression by release of known anatomical compression points can be accomplished safely and effectively via minimized skin incisions using the presented techniques. With appropriate knowledge of anatomy, this can be performed without additional risk of injury to the patient, making classically-described longer incisions unnecessarily morbid. (c) 2012 Wiley Periodicals, Inc. Microsurgery, 2012.