Retrospective Study: Tarsal Tunnel Tissue Defects

Apr 17, 2024

Wharton’s Jelly Tissue Allograft for Connective Tissue Defects Surrounding Nerves in the Tarsal Tunnel

Published January 30, 2024

Tarsal tunnel syndrome is an entrapment neuropathy of the posterior tibial nerve and can be characterized by local tenderness, pain, paresthesia, and heat, followed by numbness and tingling. Symptoms may become more permanent and severe, spreading toward the posterior, medial, or distal aspects of the lower extremity. Whether caused by age or trauma, collapsed connective tissue can cause nerve entrapment and damage within the tarsal tunnel.

This study presents an intervention targeting damaged tissues surrounding the nerves and replacing the structural cushioning with a Wharton’s jelly (WJ) tissue allograft. It highlights the significant potential of Wharton’s jelly to aid in the tissue repair of collapsed connective tissues surrounding nerves and potentially the nerve ECM as it demonstrates improved nerve sensation among patients enduring neuropathy associated with tarsal tunnel syndrome.

Methods: This study included eight patients, selected from four clinical sites, who had tarsal tunnel-related defects. The contributing clinics included Enhanced Healthcare of the Ozarks, Baycity Associates in Podiatry, Regenerative Health 360, and Advanced Medicine of the Ozarks. All patients had failed standard care practices for at least six weeks. Each patient received a Wharton’s jelly tissue allograft to sites around the affected tarsal tunnel. All methods complied with the FDA and American Association of Tissue Banks (AATB) standards. Patient outcomes were tracked on a 90-day calendar utilizing the Numeric Pain Rating Scale (NPRS) and the Western Ontario and McMaster University Arthritis Index (WOMAC).

Results: No patients experienced adverse reactions. From the initial application to the 90-day follow-up, an improvement of 59.43% in NPRS and a 37.58% improvement in WOMAC were achieved. Given the pain improvements reported on various pain rating scales, this study provides evidence that WJ allograft applications are safe, minimally invasive, and efficacious for patients who have failed standard care treatments for connective tissue defects associated with tarsal tunnel syndrome.

Conclusion: This preliminary data shows positive patient outcomes and provides grounds for future research on Wharton’s jelly tissue allografts in cases of tarsal tunnel syndrome. Read the full study here.