Abstract
We report a case in which a posterior tibial artery perforator flap was used to treat pain and difficulty in ambulation that developed after tarsal tunnel syndrome surgery.
The patient was a 70-year-old male who sustained a right foot fracture at age 18 and developed flexion contracture of the first toe. At age 66, he underwent contracture release and tarsal tunnel release at another hospital. After surgery, he developed pain in his calf and foot, making ambulation difficult.
He presented with dysesthesia around the tarsal tunnel. He had spontaneous movement of the great toe, consistent with a diagnosis of “painful legs and moving toes syndrome.” Nerve conduction study demonstrated a significant decrease in the CMAP amplitude of the posterior tibial nerve. On sonography, decreased flow was observed in the posterior tibial artery. On ankle dorsiflexion, the posterior tibial vein became occluded. Tenography and diagnostic block demonstrated compression of the posterior tibial nerve over a wide area.
Extensive neurolysis of posterior tibial nerve was performed, followed by posterior tibial artery reverse perforator flap transfer. Postoperatively, dysesthesia and pain resolved. He was able to walk without a cane.
The flap was effective in providing blood flow and soft tissue coverage over the extensively scarred posterior tibial nerve.
