II. Indications
- Tarsal Tunnel Syndrome refractory to other measures
III. Preparation
- Needle
- Gauge: 22 to 27
- Length: 1.0 to 1.5 inches
- Syringe: 3 to 5 ml
-
Corticosteroid options
- Betamethasone (Celestone) 0.5 ml of 6 mg/ml
- Methylprednisolone (Solu-Medrol): 0.5 ml of 40 mg/ml
- Triamcinolone (Kenalog) 0.5 ml of 40 mg/ml
-
Anesthetic
- Lidocaine 1%: 1 to 2 ml or
- Bupivacaine 0.25% or 0.5% 1 to 2 ml
- Ropivacaine 0.25 to 0.5% 1-2 ml
IV. Technique: Anatomic
- Patient position
- Lateral decubitus position with affected foot down
- Anatomic Landmarks
- Tunnel housing posterior tibial nerve
- Posterior to medial malleolus
- Lies immediately behind posterior tibial tendon
- Perform Tinel's Test behind posterior tibial tendon
- Mark point where tapping reproduces symptoms
- Tunnel housing posterior tibial nerve
- Sterilize local skin with Betadine or Hibiclens
- Insert needle 2 cm proximal to marked landmark
- Angle needle 30 degrees off skin surface
- Direct needle distally via marked point along tunnel
- Aspirate before injecting
- Inject at approximately 4 mm depth of needle insertion
- Patient lies supine for several minutes after procedure
- Distribute with passive foot range of motion
V. Technique: Ultrasound Guidance
- Technique is similar to anatomic as above
- Use high frequency linear probe
- Position probe in short axis (transverse to the proximal foot) over the Retinaculum at the medial ankle
- Needle is inserted in-plane
- From posterior-inferior to anterior-superior
VI. Follow-up Instructions
- No stress to foot for 2 weeks after injection
- Examine again in 3 weeks post-injection