Artery transposition using Indocyanine Green for tarsal tunnel decompression: Technical note.

BACKGROUND Surgery for idiopathic tarsal tunnel syndrome (TTS) is of limited effectiveness or ineffective. OBJECTIVE Using indocyanine green video angiography (ICG-VA) we treated idiopathic TTS by posterior tibial artery (PTA) decompression from the posterior tibial nerve (PTN) and evaluated postoperative patency of the PTA. METHOD We treated 12 patients (12 feet) with idiopathic TTS by PTA decompression from the PTN and transposed its location. The patients' age ranged from 70 - 87 years (mean 77.9 years); all were operated under local anesthesia. After a 2-cm skin incision, the flexor retinaculum was resected and the PTA was decompressed from the PTN. It was then sutured to the flexor retinaculum for decompression and to prevent compression recurrence. ICG-VA was used to confirm the absence of PTA flow disturbance and to inspect the vasa nervorum of the PTN. RESULTS We encountered no intra- or postoperative complications. Postoperatively, ICG-VA confirmed blood flow in the PTA and intactness of the vasa nervorum in all cases. One patient required adjustment of the PTA position. All patients reported symptom improvement. CONCLUSION Our surgical method of treating idiopathic TTS under ICG-VA monitoring is simple, safe, and effective.