Ryan Nishi,1,2 Jenna Tsuzaki,1,2 Shashi Sharma,1,2 Camera Nishida,1,2 Matthew Kao,1,2 Kyle Ishikawa,3 Natalia Gonzalez,1 Kore Liow,1,2 Enrique Carrazana2
1 ALS and Neuromuscular Center, Hawaii Pacific Neuroscience, Honolulu, HI
2 John A. Burns School of Medicine, University of Hawaiʻi, Honolulu, HI
3 JABSOM Biostatistics Core Facility, Department of Quantitative Health Sciences, University of Hawaiʻi John A. Burns School of Medicine, Honolulu, HI
Background: Tarsal tunnel syndrome (TTS) is a compressive neuropathy of the posterior tibial nerve that remains underdiagnosed due to its variable presentation and symptomatic overlap with other conditions. As patients increasingly turn to online platforms such as YouTube for health information, concerns have emerged regarding the reliability and comprehensibility of such content.
Methods: On December 23, 2024, YouTube was queried using the terms “tarsal tunnel syndrome,” “tarsal tunnel release,” and “tarsal tunnel injection.” After applying exclusion criteria for duplicates, unrelated content, non-English language, and short duration (<30 seconds), 88 videos were analyzed and the 50 most-viewed videos were included for analysis. Each video was assessed using three tools: the Journal of the American Medical Association (JAMA) Benchmark Criteria (0–4) for reliability, a 4-point Likert scale for comprehensibility, and a 19-point Tarsal Tunnel Syndrome-Specific Score (TTS-SS) for educational content. Video source, content type, and video power index (VPI) were also recorded. The Shapiro-Wilk test was used to assess normality; Kruskal-Wallis and Wilcoxon rank sum tests were used for comparisons, with Holm adjustment for multiple comparisons.
Results: The median TTS-SS was 5.2 (IQR 3.0–8.0). The mean JAMA and comprehensibility scores were 2.0 and 2.6, respectively. Only 10% of videos met all four JAMA criteria, and fewer than 20% were rated as highly comprehensible. Disease-specific videos had the highest TTS-SS (mean = 6.8), while non-surgical management videos scored lowest (mean = 2.8, p = 0.025). Videos by trainers and physical therapists had significantly higher VPI (mean = 338.4) than those by physicians (mean = 0.26, p < 0.001), despite lower educational scores. Surgical technique videos were the least comprehensible (mean = 1.4) compared to other content types (p < 0.05).
Conclusion: The overall quality, reliability, and comprehensibility of YouTube videos on TTS are low. While healthcare professionals produce more accurate content, their videos are less engaging than those from non-physicians. Major limitations include the dynamic nature of YouTube’s algorithm, exclusion of non-English videos, and subjective comprehensibility scoring. Efforts to improve the visibility of evidence-based content are warranted to ensure patients receive accurate online information for underrecognized conditions like TTS.
