Endoscopic Ganglionectomy and Internal Drainage of Hourglass Ganglion of the Tarsal Tunnel

Tarsal tunnel syndrome is a common entrapment neuropathy that is sometimes elicited by ganglia in the tarsal tunnel. The tarsal ganglion may penetrate through the flexor retinaculum and have an hourglass appearance with components deep and superficial to the retinaculum. The purpose of this Technical Note is to describe technical details of endoscopic management of hourglass ganglion of the tarsal tunnel. This comprises excision of the part of the ganglion superficial to the flexor retinaculum and internal drainage of the deep part of the ganglion to the tendon sheath of the posterior tibial tendon. Preserving integrity of the flexor retinaculum and the ganglion sac can minimize the risk of injury to the tibial neurovascular bundle and development of fibrous adhesion around the bundle.