Tarsal Tunnel Syndrome

Resumen para el Paciente

¿Está esto autorizado por FDA para este uso?

Not FDA-cleared for tarsal tunnel syndrome. FDA cleared medicinal leeches only for venous congestion in microsurgical reconstruction (K040187, 2004). Use here is investigational.

¿Qué evidencia existe?

Tier C (investigational). There are no published controlled trials. Evidence-based care: orthotics and supportive footwear, activity modification, NSAIDs, physical therapy with intrinsic foot strengthening and Achilles stretching, electrodiagnostic testing to stage severity, ultrasound or MRI to identify space-occupying lesions (ganglion, varicose veins, accessory muscles), local corticosteroid injection, and (refractory) tarsal tunnel release surgery. Diabetic peripheral neuropathy mimics tarsal tunnel and must be distinguished.

Riesgos principales

• Bleeding from each bite site for 6 to 24 hours after detachment
• Bruising over the medial ankle for 5 to 10 days
• Local skin or, rarely, Aeromonas hydrophila infection
• Allergic reaction to leech saliva (uncommon)
• RISK if leech is placed directly over the tarsal tunnel or posterior tibial nerve
• Worsening paresthesia from local tissue swelling near the nerve
• Delay of imaging if a space-occupying lesion is responsible
• Delay of surgical release in patients with motor weakness who need it
• RISK in diabetic patients with reduced sensation and impaired healing

Quién no debería considerar esto

• Patients with diabetes, peripheral arterial disease, or impaired protective sensation on monofilament testing
• Patients with intrinsic foot muscle wasting or motor weakness (this needs surgical release)
• Patients without electrodiagnostic confirmation
• Patients without imaging to exclude space-occupying lesions (ganglion, varicose veins, accessory muscles, tenosynovitis)
• Patients who have not tried orthotics, supportive footwear, and physical therapy
• Patients on anticoagulants, with hemophilia, or with severe anemia
• Patients with active dermatitis or broken skin over the medial ankle

Qué preguntar a su clínico

• Have I had electrodiagnostic testing (nerve conduction studies)?
• Have I had ultrasound or MRI to look for space-occupying lesions (ganglion, varicose veins, accessory muscles)?
• Have we ruled out diabetic peripheral neuropathy or lumbar radiculopathy as alternatives?
• Have I tried orthotics, supportive footwear, NSAIDs, and physical therapy?
• Am I a candidate for local corticosteroid injection or surgical tarsal tunnel release?
• Where exactly will the leech be placed - confirm it is NOT directly over the tarsal tunnel or posterior tibial nerve?
• What is the Aeromonas-prevention protocol given the foot is a higher-risk area?

Cuándo buscar atención urgente

• Sudden severe foot weakness, foot drop, or inability to push off
• Sudden numbness in the entire sole of the foot
• Acute swelling, severe pain, or cold pallor of the foot
• Non-healing wound or ulcer at the bite site
• Bleeding from a bite site lasting more than 24 hours
• Fever, chills, or spreading redness at the bite site
• Hives, facial or throat swelling, or breathing difficulty