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tarsal tunnel syndrome (posterior tibial neuropathy)
Entrapment of the posterior tibial nerve in its 3rd compartment of the flexor retinaculum tunnel just posterior to the medial malleolus. Also see carpal tunnel syndrome.
Etiology:
1) fracture involving the tarsal tunnel
2) ganglion in the adjacent tendon sheath
3) lipoma
4) severe pronation (flat foot) with secondary stretch of the posterior tibial nerve
Clinical manifestations:
1) paresthesias in the arch of the foot
2) numbness of the toes
3) proximal & medial radiation of pain may occur into the leg
4) symptoms are aggravated by activity
5) positive Tinel's sign with pain after percussion over the region of the posterior tibial nerve
Management: also see carpal tunnel syndrome
1) non-steroidal anti-inflammatory agents (NSAIDs)
2) hind foot orthoses to limit pronation of the heel & stretching of the posterior tibial nerve
3) corticosteroid injections give variable results
4) surgical release of the entire tarsal tunnel
Related
carpal tunnel syndrome (median neuropathy)
paresthesia; burning; tingling
posterior tibial nerve
Tinel's sign
General
entrapment neuropathy; nerve entrapment syndrome; pinched nerve
References
- UCLA Intensive Course in Geriatric Medicine & Board Review,
Marina Del Ray, CA, Sept 12-15, 2001
- Geriatrics Review Syllabus, American Geriatrics Society,
5th edition, 2002-2004
- Geriatric Review Syllabus, 8th edition (GRS8)
Durso SC and Sullivan GN (eds)
American Geriatrics Society, 2013