Tarsal tunnel syndrome: current rationale, indications and results

Abstract

Tarsal tunnel syndrome (TTS) is a neuropathy due to compression of the posterior tibial nerve and its branches. It is usually underdiagnosed and its aetiology is very diverse. In 20% of cases it is idiopathic. There is no test that diagnoses it with certainty. The diagnosis is usually made by correlating clinical history, imaging tests, nerve conduction studies (NCSs) and electromyography (EMG). A differential diagnosis should be made with plantar fasciitis, lumbosacral radiculopathy (especially S1 radiculopathy), rheumatologic diseases, metatarsal stress fractures and Morton’s neuroma. Conservative management usually gives good results. It includes activity modification, administration of pain relief drugs, physical and rehabilitation medicine, and corticosteroid injections into the tarsal tunnel (to reduce oedema). Abnormally slow nerve conduction through the posterior tibial nerve usually predicts failure of conservative treatment. Indications for surgical treatment are failure of conservative treatment and clear identification of the cause of the entrapment. In these circumstances, the results are usually satisfactory. Surgical success rates vary from 44% to 96%. Surgical treatment involves releasing the flexor retinaculum from its proximal attachment near the medial malleolus down to the sustentaculum tali. Ultrasound-guided tarsal tunnel release is possible. A positive Tinel’s sign before surgery is a strong predictor of surgical relief after decompression. Surgical treatment achieves the best results in young patients, those with a clear aetiology, a positive Tinel’s sign prior to surgery, a short history of symptoms, an early diagnosis and no previous ankle pathology. Cite this article: EFORT Open Rev 2021;6:1140-1147. DOI: 10.1302/2058-5241.6.210031

Accessory Tibionavicular Muscle: An Unusual Cause of Medial Ankle Pain

“…Common causes of medial ankle pain include injuries to the ankle bones, capsuloligamentous structures, tendons, arthritis, degenerative tendinopathies particularly of the tibialis posterior tendon, compressive neuropathy (tarsal tunnel syndrome), or soft tissue tumors. [13][14][15] One of the rare causes of ankle pain can be due to accessory muscle or its pathological presentation. 4 Though accessory, anomalous or supernumerary muscles around the ankle are well described, these can rarely cause symptoms of pain due to tears of the accessory muscles, paraesthesia due to compressive neuropathy, and rarely as a soft tissue tumor mimic.…”

Fracture of The Sustentaculum Tali: Features and Surgical Management for Fracture Reduction

“…[20][21][22] Tarsal tunnel syndrome, along with nonunion, is also sometimes seen. 4,20,23 In this study, out of ten patients, three patients were lost to follow-up. Five of the seven patients had dislocation of the subtalar joint, and two had Intra-articular middle facet involvement.…”

Imaging of Tendinous and Muscular Anatomical Variants Around the Ankle

“…8 Tarsal tunnel syndrome is an entrapment neuropathy due to the compression of the posterior tibial nerve and its branches. 9…”