During acute varus deformity correction, which procedure should be performed prophylactically?

• A. Plantar fascia release
• B. Achilles tendon lengthening
• C. Ankle arthrodesis
• D. Tarsal tunnel release

Answer: (D)

When correcting an acute hindfoot varus deformity, the tissues in the tarsal tunnel can be stretched or compressed as the foot realigns and swelling occurs. Doing a prophylactic tarsal tunnel release decompresses the posterior tibial nerve, reducing the risk of developing postoperative tarsal tunnel syndrome that can accompany aggressive realignment. Other procedures target different structures—plantar fascia release addresses plantar fasciitis, Achilles lengthening tackles tight gastroc-soleus complex, and ankle arthrodesis fuses the ankle joint—which don’t prevent nerve compression in the tarsal tunnel. So, prophylactic tarsal tunnel release is the preventive step to guard against neuropathic complications during acute varus correction.