The Tarsal Tunnel Syndrome is a pathology that compresses a nerve at the level of the ankle and produces heel pain, often radiated to other areas of the foot, burning sensation, cramps, numbness and other symptoms. This discomfort can occur both at rest and in movement, so that those who suffer it are limited in their movements: many times they cannot walk medium distances, even small ones, nor do sport. The surgery traditionally used to release this nerve requires an incision of 4-8 centimetres, sometimes even 12 centimetres, in a particularly delicate area. But a Spanish podiatrist and physiotherapist has successfully performed this same operation with a tiny cut of only 2 millimetres.

This is a new type of surgery that is increasingly present, the so-called eco-guided surgery, much less invasive even than arthroscopic, laparoscopic or endoscopic surgery, which makes incisions of half a centimetre. “In this case they are reduced to 2 millimetres, we are talking about ultra-minimally invasive surgery”, says the specialist.

Alejandro Fernández Gibello, a podiatrist from Cáceres, together with his colleagues Gabriel Camuñas Nieves and Rubén Montes Salas from the Vitruvio Instituto de Biomecánica y Cirugía team, have become the first to publish worldwide the description of a novel eco-guided surgical technique for the treatment of tarsal tunnel syndrome through its proximal side.

At only 26 years old, he has been the main author of this innovative and pioneering study that has had the collaboration of a national and international team of researchers and podiatrists and doctors.

The publication of this technique will make it possible to cure the tarsal tunnel syndrome by reducing the incision and scar, which was previously around 6 cm, to approximately 2 mm. This achievement also reduces possible complications and will allow the surgical intervention of diabetic patients who were not previously operated on by open or conventional surgery due to their possible risks and adverse effects.

This technique has several advantages: the incision and tissue damage are reduced to a minimum, the scar is minimized (one of the main risk factors of this pathology), a tourniquet is not required, which reduces postoperative pain, the patient walks out of the operating room and recovery times are reduced, as has been seen in extrapolable studies of ecoguided surgery of the carpal tunnel.

The research, entitled Ultrasound-guided decompression surgery of the tarsal tunnel:a novel technique for the proximal tarsal tunnel syndrome-Part II, published in the prestigious journal ‘Surgical and Radiologic Anatomy’ on 31 October 2018, represents a breakthrough in tarsal tunnel syndrome surgery.

According to Alejandro Fernández Gibello, a podiatrist and physiotherapist at the Clínica Vitruvio Instituto de Biomecánica & Cirugía in Madrid, one of its main objectives is “to research, share, disseminate and teach fellow podiatrists cutting-edge techniques for the advancement of the profession”. In this way, the podiatrist indicates that “the professionals will have a better management of the diagnosis and treatment of foot and ankle pathologies”.