II. Indications

  1. Tarsal Tunnel Syndrome refractory to other measures

III. Preparation

  1. Needle
    1. Gauge: 25 to 27
    2. Length: 1.0 to 1.5 inches
  2. Syringe: 3 to 5 ml
  3. Corticosteroid options
    1. Betamethasone (Celestone) 0.5 ml of 6 mg/ml
    2. Methylprednisolone (Solu-Medrol): 0.5 ml of 40 mg/ml
  4. Anesthetic
    1. Lidocaine 1%: 1 to 2 ml or
    2. Bupivacaine 0.25% or 0.5%: 1 to 2 ml

IV. Technique

  1. Patient position
    1. Lateral decubitus position with affected foot down
  2. Landmarks
    1. Tunnel housing posterior tibial nerve
      1. Posterior to medial malleolus
      2. Lies immediately behind posterior tibial tendon
    2. Perform Tinel's Test behind posterior tibial tendon
      1. Mark point where tapping reproduces symptoms
  3. Sterilize local skin with betadine or hibiclens
  4. Insert needle 2 cm proximal to marked landmark
    1. Ankle needle 30 degrees off skin surface
    2. Direct needle distally via marked point along tunnel
    3. Aspirate before injecting
  5. Patient lies supine for several minutes after procedure
    1. Distribute with passive foot range of motion

V. Follow-up Instructions

  1. No stress to foot for 2 weeks after injection
  2. Examine again in 3 weeks post-injection

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