Pilot Study: Innovative Minimally Invasive Tarsal Tunnel Release for Diabetic Foot Ulcer Patients Minimizing Drawbacks

Abstract

Background:. Diabetic foot ulcers are challenging to manage due to the multifactorial nature of the disease, with diabetic neuropathy being a primary contributing factor. Tarsal tunnel release has shown promise in restoring sensation, reducing ulcer recurrence through improved sensation, and enhancing microcirculation to promote ulcer healing. However, existing open and endoscopic techniques have notable limitations. This study introduces a novel minimally invasive tarsal tunnel release technique designed to address these shortcomings. Methods:. A retrospective cohort study was conducted at Sengkang General Hospital, a tertiary care center. The control group comprised 22 consecutive patients who underwent open tarsal tunnel release, whereas the treatment group included 34 consecutive patients treated with the novel minimally invasive approach. All patients were followed up for a minimum of 3 months. Results:. Both groups demonstrated comparable efficacy in improving sensation (100% versus 95.5%) and 2-point discrimination (88.2% versus 86.4%; P = 0.19, P = 0.83, respectively). However, the treatment group exhibited significantly shorter wound lengths (2.3 ± 0.26 versus 5.8 ± 0.72 cm; P < 0.0001) and a faster wound healing duration (15 ± 5 versus 24 ± 17 d; P = 0.0052). Additionally, the treatment group experienced no major wound complications compared with a 13.6% complication rate in the control group (P = 0.029). Conclusions:. This minimally invasive novel technique demonstrates similar efficacy in improving sensation while addressing the limitations of existing open and endoscopic methods. It offers significant advantages in terms of reduced wound size, faster healing, and lower complication rates.