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Self-Assessment Questions

Orthopaedic Surgery

Answer 4
  1. If the bifurcation of the tibial nerve beneath the lacinate ligament is enlarged, surgically cutting the ligament provides space for nerve expansion. Most cases of TTS occur from idiopathic entrapment and compression of the tibial nerve by the lacinate ligament. The bifurcation of the tibial nerve and medial and lateral plantar nerves occurs just below the lacinate ligament in 93% of cases, and cutting the ligament frees space for the enlarged nerve.4 Fibrous fascial tethers of tibial nerve branches to the abductor hallucis muscle must be completely removed, and removal of a section of the flexor retinaculum over the neurovascular bundle is highly recommended to reduce compression. Before surgical treatment, conservative trials of anti-inflammatory agents (nonsteroidal anti-inflammatory drugs, corticosteroids) often successfully relieve discomfort. Custom-fit orthotics, wide-cushioned shoes, and arch supports can also effectively treat TTS.4

     Aldridge T. Diagnosing heel pain in adults. Am Fam Physician 2004;70:332-8.

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