Download Patellar Tendinopathy

Tarsal Tunnel Syndrome
Normal Anatomy
• Tibial nerve is the medial component
of the sciatic nerve
• Tibial nerve comes to the surface at
the level of the medial side of the
ankle
• Enters the tarsal tunnel between the
medial malleolus and achilles tendon
with the posterior tibial artery and
vein
• Tarsal Tunnel is an osteofibrous canal
covered by the flexor retinaculum
• Tibial nerve splits in the Tarsal Tunnel
into the medial and lateral plantar
nerves
Pathology
• Irritation of the peripheral nerve
within the Tarsal Tunnel
Mechanism of Injury
• Insidious
• Space occupying lesions
• Repetitive stress through running
or walking
• Muscle and Tendon Hypertrophy
• Excessive weight
• Rheumatoid Arthritis
• Traumatic
• Fractures
• Dislocation
• Ligament sprains
Subjective Examination
• Tingling or numbness around the
medial ankle and plantar surface
of the foot
• Pain with prolonged standing or
walking
• Burning sensation at night
Objective Examination
• Pain on palpation of the nerve
on the medial ankle
• Painful sustained dorsiflexion
plus eversion
• Loss of sensation medial aspect
of the foot
• Reduced power of the toe
abductors and flexors
• Percussion of posterior tibial
nerve causes paraesthesia
Further Investigation
• Electrophysiological testing
(Nerve Conduction Velocity
testing)
• X-ray
• MRI
Management
• Goal of management to reduce the compression within the tarsal
tunnel
Conservative
• Reduce pain and inflammation
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Ice
NSAID’s
Orthotics
Night Splints
Taping
Massage
• Restore Normal Range of Movement
• Ankle and Foot
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Soft tissue massage
Foam rolling
Stretching
Dry needling
Joint mobilisations
Joint manipulations
Neurodynamic mobilisations
• Restore Normal Muscle Activation
• Intrinsic foot muscles
Plan B
• Corticosteroid Injection
• Surgical decompression
References
• Ahmad, M., K. Tsang, P. J. Mackenney and A. O. Adedapo (2012).
"Tarsal tunnel syndrome: A literature review." Foot Ankle Surg 18(3):
149-152.
• Antoniadis, G. and K. Scheglmann (2008). "Posterior Tarsal Tunnel
Syndrome: Diagnosis and Treatment." Dtsch Arztebl Int 105(45): 776781.
• Hudes, K. (2010). Conservative management of a case of tarsal tunnel
syndrome. J Can Chiropr Assoc. 54: 100-106.