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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 • • • • • • Ice NSAID’s Orthotics Night Splints Taping Massage • Restore Normal Range of Movement • Ankle and Foot • • • • • • • 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.
