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

• Kim GB
• Park CH

• KMID: 2407375
• DOI: http://doi.org/10.14193/jkfas.2018.22.1.44

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

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  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.

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

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

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  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.

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  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.

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  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).

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

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