-Original-

Symptom Improvement after Surgery for Tarsal Tunnel Syndrome

Minoru Ideguchi¹, Kyongsong Kim¹, Satoshi Yamaguchi², Toyohiko Isu³, Hiroyuki Dan¹, Riku Mihara¹, Kenta Koketsu¹ and Yasuo Murai⁴

¹Department of Neurological Surgery, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
²Department of Neurosurgery, University of Iowa Health Care, Iowa, USA
³Department of Neurosurgery, Kushiro Rosai Hospital, Hokkaido, Japan
⁴Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan

Background: Tarsal tunnel syndrome (TTS) is an entrapment neuropathy of the posterior tibial nerve in the tarsal tunnel. Patients with TTS exhibit plantar symptoms, including numbness, foreign body sensation, and cold/burning sensation. We investigated postoperative improvement of symptoms and the association of preoperative symptoms with surgical outcomes in patients with idiopathic TTS.
Methods: We enrolled 17 consecutive patients (21 sides) with idiopathic TTS (mean age 68.6 years). The presence and severity of symptoms were evaluated before and 6 months after surgery and recorded on a numeric rating scale (NRS). Major preoperative symptoms noted were numbness in 14 patients, foreign body sensation in 13 patients, and cold/burning sensation in 5 patients. Some patients had multiple major symptoms. Patient satisfaction was recorded on an NRS at 6 months postoperatively.
Results: Postoperative patient satisfaction was 7.0. Improvement in foreign body sensation was weakest, although the difference as compared with other symptoms was not significant. Patients with foreign body sensation and at least one other major symptom reported significantly lower symptom improvement and treatment satisfaction. There was no significant difference in perceived improvement between those reporting numbness and cold/burning sensation as major symptoms and those who did not.
Conclusions: Patients reporting foreign body sensation as a major symptom were significantly less satisfied with the outcome of surgery than other patients. Our findings may help predict satisfaction with surgical outcomes in patients with idiopathic TTS.

J Nippon Med Sch 2026; 93: 318-322

Keywords
symptoms, surgery, tarsal tunnel syndrome, nerve compression, surgical outcome

Correspondence to
Kyongsong Kim
kyongson@nms.ac.jp

Received, March 30, 2026
Accepted, May 18, 2026