• Rinko Kokubo, Kyongsong Kim, Toyohiko Isu, Daijiro Morimoto, Naotaka Iwamoto, Shiro Kobayashi, and Akio Morita.
• Department of Neurosurgery, Chiba Hokuso Hospital, Nippon Medical School, Kamagari, Inzai, Chiba, Japan. Electronic address: rin-ko927@nms.ac.jp.
• World Neurosurg. 2016 Aug 1; 92: 249-254.

ObjectiveTarsal tunnel syndrome (TTS) is an entrapment neuropathy of the posterior tibial nerve in the tarsal tunnel. It is not known whether vascular or neuropathic factors are implicated in the cause of a cold sensation experienced by patients. Therefore, we studied the cold sensation in the pedal extremities of patients who did or did not undergo TTS surgery.MethodsOur study population comprised 20 patients with TTS (38 feet); 1 foot was affected in 2 patients and both feet in 18 patients. We acquired the toe-brachial pressure index to evaluate perfusion of the sole and toe perfusion under 4 conditions: the at-rest position (condition 1); the at-rest position with compression of the foot dorsal artery (condition 2); the Kinoshita foot position (condition 3); and the Kinoshita foot position with foot dorsal artery compression (condition 4). Patients who reported abatement in the cold sensation during surgery underwent intraoperative reocclusion of the tibial artery to check for the return of the cold sensation.ResultsThe toe-brachial pressure index for conditions 1 and 3 averaged 0.82 ± 0.09 and 0.81 ± 0.11, respectively; for conditions 2 and 4, it averaged 0.70 ± 0.11 and 0.71 ± 0.09, respectively. Among the 16 operated patients, the cold sensation in 7 feet improved intraoperatively; transient reocclusion of the tibial artery did not result in the reappearance of the cold sensation.ConclusionsOur findings suggest that the cold sensation in the feet of our patients with TTS was associated with neuropathic rather than vascular factors.Copyright © 2016 Elsevier Inc. All rights reserved.

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