Tarsal Tunnel Syndrome Caused by a Talocalcaneal Joint Amyloidoma in a Long-Term Haemodialysis Patient: A Case Report

Abstract

We present a case of tarsal tunnel syndrome caused by an amyloidoma arising from the talocalcaneal joint in a 64-year-old man with a long history of haemodialysis. He presented with numbness in the medial plantar area of the right foot without any antecedent trauma. The numbness was minimal at rest but gradually worsened, causing difficulty, when walking. Paraesthesia was present on the medial sole of the right foot. A positive Tinel-like sign was noted 2.5 cm below the medial malleolus. Magnetic resonance imaging demonstrated a round lesion, 1 cm in diameter, in the calcaneus, which was hypointense on T1-weighted images and hyperintense on T2-weighted images. In addition, a mass, 1 cm in diameter with a signal isointense to that of muscle was found adjacent to the talocalcaneal joint. The medial plantar nerve was decompressed after removing a solid, 1-cm diameter mass from the talocalcaneal joint. At 6 months post surgery, the numbness had completely resolved. No recurrence was observed at the 24-month follow-up.

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 in Hemodialysis Patients

“…16,20,24,25 Therefore, studies on the occurrence and pathological process of tarsal tunnel syndrome in dialysis patients have been difficult.…”

“…However, reports regarding tarsal tunnel syndrome among dialysis patients are very rare and mostly consist of case reports. 16,20,24,25 Therefore, studies on the occurrence and pathological process of tarsal tunnel syndrome in dialysis patients have been difficult.…”

“…7 However, reports regarding tarsal tunnel syndrome in long-term dialysis patients are very rare and only case reports exist; thus, the epidemiological and pathological characteristics of tarsal tunnel syndrome in long-term dialysis patients still are not fully understood. 16,20,24,25 The purpose of our study was to investigate tarsal tunnel syndrome arising in patients who have undergone maintenance dialysis at our facility and to evaluate the frequency of tarsal tunnel syndrome and the problems with its pathological features and diagnosis.…”

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

“…Tension secondary to hindfoot valgus has also been demonstrated as an isolated source, as well as exacerbating other causes [ 8 ]. Unusual causes that have been previously described include secondary to a partial rupture of the flexor hallucis longus tendon [ 9 ], amyloidoma following haemodialysis [ 10 ], and angioleiomyoma [ 11 ]. An underlying pathology is absent in up to 50% of cases [ 12 ].…”