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O U T S I D E O F TR U E space- occupying mass etiologies, the tarsal tunnel release for treatment of recalcitrant nerve pain and paresthesia of the plantar foot has not enjoyed the same regularity of success that the carpal tunnel release has. Reasons for this lack of predictability have been postulated by many authors over the years. Variations in anatomy, technique, and postoperative management have been proposed. However, pronation-driven stress along the tarsal tunnel has not been addressed beyond a mention in the majority of outcome reviews. In this author's practice, mechanical loading of tibial nerve and tarsal tunnel tension by a combination of foot type, work demands, shoe type, and excess body weight has been the most common etiologic factor present in these patients. Given the above, it is easy to draw a correlation between a mechanically sensitive nerve tunnel and the overall lack of truly predictable success seen following release of that tunnel. At the very least, a call for more outcome studies that separate out variables such as foot type, lifestyle and body weight, in addition to surgical and postoperative management techniques, could be made. Finally, it may be wise for the foot and ankle surgeon to approach this syndrome carefully and realize that there will likely be etiologic factors in a majority of patients that cannot be adequately impacted by the surgery alone. Dr. Whitaker is board certified by the American Board of Foot and Ankle Surgery and a Fellow of the American College of Foot and Ankle Surgeons. He is Division Head and Associate Professor of Podiatric Surgery at Kent State University College of Podiatric Medicine in Independence, Ohio. ■ Reference: Reichert P, Zimmer K, Wnukiewicz W, Kuli´nski S, Mazurek P, Gosk J. Results of surgical treatment of tarsal tunnel syndrome. Foot Ankle Surg. 2015 Mar; 21(1):26-29. HEALTHCARE ADVOCATES, INDUSTRY LEADERS With more than 40 years of experience, our Healthcare Section offers Healthcare Representation & Counseling, Coding Review and Staff Training. We make it possible for you to focus on patient care, while we tackle the legal obstacles you are faced with on an ongoing basis. WE ARE THE HEALTHCARE SECTION OF KRUGLIAK, WILKINS, GRIFFITHS & DOUGHERTY, CO., L.P.A. 4775 Munson Street N.W. | P.O. Box 36963 | Canton, Ohio 44735 | 330-497-0700 | Fax 330-497-4020 John M. Tucker • Randall C. Hunt • Fred J. Haupt Jason F. Haupt • Laura A. Brady Offices in Canton, Akron, Alliance, New Philadelphia & Sugarcreek KWGD.com +++++++++++++++++++++++++++++++++++++++++++ + +++ + +++ +++++++++++++++++++++++++++++++++++++++++++ SPECIAL CLINICAL SECTION: PODIATRY ❯ Tarsal Tunnel Syndrome By Jeffrey M. Whitaker, DPM, FACFAS The Realities of 2 0 1 5 M AY/J U N E ■ M D N E W S . CO M ■ MD NEWS Cleveland/Akron/Canton | 1 7