A very difficult procedure since one never knows (unless the revision surgeon was the initial surgeon, in which case the laws of diminishing returns should apply)
ALL OTHER INTANGIBLES BEING EQUAL, I find a few common "errors" in surgeons performing unsuccessful TT Decompressions:
1. The Porta Pedis is not, or not completely, released.
2. If varicosities exist they need to be ligated, no matter how difficult or how much time it may take.
3. Post operative protocol is important. If the surgeon does not understand the post operative measure which are needed for proper wound healing then the possibility of failure increases, regardless of how well the surgery itself was performed.
4. If the patient has any classic heel spur/fasciitis pain then perform a faciotomy/spur resection along with the release.
5. A suspected non compliant patient should not be booked for surgery.
Basically, in my humble opinion, Tarsal Tunnel release is a demanding procedure if you want repeatable, high success rates. This is not a procedure that should be done by the inexperienced 3 or 4 times a year, nor by the surgeon incapable and
not trained to deal with the possible intra and post operative complications.