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• W2972321899 abstract "INTRODUCTION: One of the treatments of lower extremity neuropathy is similar to Raynaud’s disease: sympathectomy1 with nerve decompression.2 The tarsal tunnel decompression can change lower extremity neuropathy and decrease ulceration and amputation,2 and growing evidence suggests nerve decompression as a choice treatment.3 The benefits of decompression include improvement of sensation, increased perfusion with vasodilatation, and a decrease of pain.4 We describe an anatomical study with findings of a muscle variant, the flexor digitorum accessorius longus (FDAL), in the tarsal tunnel that can affect neuropathy symptoms by acting as a space-occupying lesion, contributing to tibial nerve compression. METHODS: Dissection of 40 legs on 20 cadaveric specimens was performed at West Virginia University to assess the prevalence of the FDAL muscle and also to assess the potential for neurovascular entrapment due to the mass effects of the FDAL muscle itself. RESULTS: After completing 40 leg dissections, 3 variant FDAL muscles (7.5%) were identified, and their anatomical relationships to the tibial nerve and posterior tibial vasculature were noted. Photographs of the FDAL muscles and further descriptions of the origin, course, relationship in the tarsal tunnel, and insertion will be presented. DISCUSSION: The entrapment of the tibial nerve can lead to tarsal tunnel syndrome and neuropathy. Although there are many etiologies for tarsal tunnel syndrome, the presence of the FDAL, a variant muscle, has been shown to cause tarsal tunnel syndrome in patients.5 The incidence of the FDAL muscle has been reported as 6% of asymptomatic individuals during magnetic resonance imaging studies and 2%–8% of lower limbs in cadaveric studies.5 Due to the prevalence of this muscle, physicians performing a tarsal tunnel decompression for diabetic neuropathy should review the available imaging to rule out the presence of this variant leg muscle. Because of the size and location of the FDAL within the tarsal tunnel, tarsal tunnel decompression by incising the flexor retinaculum may not resolve the patient’s neuropathy symptoms. An additional excision of the variant muscle may be warranted to optimize treatment efficacy. REFERENCES: 1. McCall TE; Petersen DP; Wong LB. The use of digital artery sympathectomy as a salvage procedure for severe ischemia of Raynaud’s disease and phenomenon. J Hand Surg. 1999;24:173. 2. Aszmann O, Tassler PL, Dellon AL. Changing the natural history of diabetic neuropathy: incidence of ulcer/amputation in the contra-lateral limb of patients with unilateral nerve decompression procedure. Ann Plast Surg. 2004;53:517. 3. Nickerson DS. Nerve decompression and neuropathy complications in diabetes: are attitudes discordant with evidence? Diabetic Foot Ankle. 2017;8 Article:1367209. 4. Trignano E, Fallico N, Chen HC, et al. Evaluation of peripheral microcirculation improvement of foot after tarsal tunnel release in diabetic patients by transcutaneous oximetry. Microsurgery. 2016;36:37–41. 5. Lambert HW. Leg muscles. In: Tubbs RS, Shoja MM, Loukas M, eds. Bergman’s Comprehensive Encyclopedia of Human Anatomic Variation. Hoboken, N.J.: Wiley Publishing; 2016:421–437." @default.
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• W2972321899 date "2019-08-01" @default.
• W2972321899 modified "2023-09-27" @default.
• W2972321899 title "Tarsal Tunnel Musculature Variant to Consider When Performing a Tarsal Tunnel Release in the Treatment of Diabetic Neuropathy" @default.
• W2972321899 doi "https://doi.org/10.1097/01.gox.0000584956.29771.4b" @default.
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