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The authors present a modified method for treating painful cicatrix nerve entrapments. A series of three high-volume injections of local anesthetic, steroid, and hyaluronidase are used to perform percutaneous adhesiotomies and extraneural fibrosis decompression. If special attention is given to the tissue plane level in performing the sequential injections, circumferential neural trunk decompression or cicatrix adhesiotomy can be obtained. The procedure may decrease or eliminate pain sufficiently to circumvent surgical intervention.
The authors introduce the peroneal tendon balance procedure and discuss normal and hypermobile function of the first ray. The procedure is based on the theory that the peroneus longus tendon is a primary retrograde stabilizer of the proximal portion of the first ray. The theory emphasizes that abnormal pronation results in a positional weakness of the peroneus longus tendon, which induces first ray hypermobility. This surgical procedure involves an anastomosis of the peroneus longus to the peroneus brevis tendon. It is designed to increase the force of the peroneus longus tendon in order to reduce first ray hypermobility.
The results of the study indicate that tarsal tunnel syndrome is a pathologic condition in which there are multiple etiologies, which in some cases are poorly defined. In order to arrive at a definitive diagnosis, all available tests, including pathology reports, are important. Where proper diagnosis is made and followed with appropriate adjunctive care, the probability of recurrence will be minimized. Statistical information in itself is of some value, because it may help the podiatrist to more clearly diagnose and treat the patients in whom vague or general symptoms may exist.
