# Wharton’s Jelly Tissue Allograft for Connective Tissue Defects Surrounding Nerves in the Tarsal Tunnel: A Retrospective Case Series

## TL;DR

This study explores using Wharton’s jelly tissue allografts to treat nerve-related connective tissue defects in the tarsal tunnel, showing pain and function improvements in patients.

## Contribution

The novel use of Wharton’s jelly allografts for tarsal tunnel syndrome in patients unresponsive to standard care is introduced.

## Key findings

- Patients showed a 59.43% improvement in pain scores and 37.58% improvement in function over 90 days.
- No adverse reactions were observed with the allograft treatment.
- The allograft was found safe, minimally invasive, and effective for tissue defects in tarsal tunnel syndrome.

## Abstract

Caused by age or trauma, collapsed connective tissue can cause nerve entrapment and damage within the tarsal tunnel. Tarsal tunnel syndrome is relatively underdiagnosed. This study presents an intervention targeting damaged tissues surrounding the nerves and replacing the structural cushioning with a Wharton’s jelly tissue allograft. The eight patients in our study, selected from four clinical sites, had tarsal tunnel-related defects. 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). 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. No patients experienced adverse reactions. The percent change results calculated from the initial application to the 90-day follow-up showed an improvement of 59.43% in NPRS and a 37.58% improvement in WOMAC. This study provides evidence that WJ allograft applications are safe, minimally invasive, and efficacious for patients who have failed standard care treatments for tissue defects associated with tarsal tunnel syndrome. The limitations of this study include its small cohort size and nonblinded nature. The results of this study warrant further research to confirm the efficacy, optimal dose, protocol, and durability of Wharton’s jelly.