Tarsal Tunnel Syndrome

Tarsal tunnel syndrome is caused by entrapment of the posterior tibial nerve under the flexor retinaculum or at the site of either of its branches, the medial or lateral plantar nerves. The tunnel is formed by the flexor retinaculum, which is located behind and distal to the medial malleolus. Pain and paresthesias radiate along the plantar aspect of the foot from the medial malleolus and increase with activity. A positive Tinel's sign (paresthesias with percussion over the inflamed nerve) may be found along with increased discomfort from prolonged manual compression of the posterior tibial nerve behind the medial malleolus. There are many causes of this disorder, including posttraumatic deformities, tortuous veins, ganglion, lipoma, edema, the presence of accessory muscles, and synovial hypertrophy. Careful selection of candidates for resection of a space-occupying lesion has the best chance of success because of the high rate of complications and patient dissatisfaction with results.50 MRI is helpful when planning the surgery for refractory cases of tarsal tunnel syndrome, as it identifies an inflammatory or mass lesion.51

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