Calcaneal osteomyelitis presenting with acute tarsal tunnel syndrome: a case report

Abstract

IntroductionCases of acute tarsal tunnel syndrome are rare. To the best of our knowledge, we describe the only reported case of acute posterior tibial nerve compression resulting from adjacent haemotogenous pyogenic calcaneal osteomyelitis.Case presentationA previously healthy 38-year-old Caucasian woman developed symptoms of acute tarsal tunnel syndrome in her right foot over a six-day period. No antecedent trauma or systemic symptoms were noted. Magnetic resonance imaging and bone scan imaging, followed by surgical decompression and bone biopsy confirmed a diagnosis of Staphylococcus aureus calcaneal osteomyelitis. Her pain and paraesthesia disappeared after the operation, while her inflammatory markers normalised during a 12-week course of antibiotics. After four years she has remained asymptomatic without any indication of recurrence.ConclusionThis case is not just unique in describing osteomyelitis as a cause of tarsal tunnel syndrome, because haemotogenous calcaneal osteomyelitis is in itself a rare pathology. We recommend considering infection as a differential diagnosis in patients presenting with acute tarsal tunnel syndrome.

The Effect of Medial and Lateral Calcaneal Osteotomies on the Tarsal Tunnel

“…Often patients demonstrate a positive Tinel sign along the course of the tibial nerve, and become more symptomatic with dorsiflexion and eversion at the ankle. 7 Although multiple causes of tarsal tunnel syndrome have been described, including trauma, 11,13 space occupying lesions, 9,17 infection, 2 systemic diseases, 15,16 external compression, 11,19 and ischemia, 1 few reports make any mention of compressive or traction neuropathy as a direct potential result of corrective osteotomy. This mechanism, however, has on 2 occasions been observed by the senior author as the likeliest reason for transient postoperative neuropathy after otherwise uneventful calcaneal tuber translation.…”

Tarsal Tunnel Syndrome Due To Varicose Vascular Structures: A Case Report

“…The tendons of tibialis posterior, flexor digitorum longus and flexor hallucis longus, the posterior tibial nerve, artery and vein run together through the tarsal tunnel. 1,2 The tarsal tunnel syndrome can be caused by extrinsic or intrinsic pressure on the posterior tibial nerve or on its terminal branches: the medial plantar nerve, the lateral plantar nerve, the medial calcaneal nerve, the motor branch to the abductor muscle of the fifth toe and/or the inferior calcaneal nerve. 1,2 Diagnosis is usually based on physical examination and can be confirmed by electrophysiological evidence.…”