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Posterior Tarsal Tunnel SyndromeAka: Tarsal Tunnel, Tibial Neuropathy, Posterior Tibial Nerve Entrapment
- Anatomy (See Ankle Anatomy)
- Posterior Tibial Nerve
- Behind medial malleolus and under flexor retinaculum
- Flexor Retinaculum
- Arises from medial malleolus
- Insertion into medial calcaneus
- Encases
- Posterior tibial nerve
- Tibialis posterior tendon
- Flexor digitorum longus tendon
- Flexor hallucis longus tendon
- Posterior tibial artery
- Posterior tibial vein
- Posterior Tibial Nerve
- Epidemiology
- Uncommon
- Pathophysiology
- Posterior Tibial Nerve compressed in flexor retinaculum
- Associated Conditions
- Phlebitis
- Rheumatoid Arthritis
- Pes planus
- Foot Fracture
- Foot traction injury
- Heel or foot deformity
- Foot mass lesion
- Symptoms
- Burning, numbness, or tingling sensation
- Starts at plantar heel
- May radiate to distal sole of foot to toes
- May radiate to calf
- Provocative
- Worse with ambulation
- Worse at night
- Burning, numbness, or tingling sensation
- Signs
- Sensory loss in posterior tibial nerve distribution
- Motor function usually intact
- Intrinsic Muscle Weakness may be present
- Provocative maneuvers may elicit symptoms
- Tinel's sign
- Percussion over tarsal tunnel (Flexor Retinaculum)
- Identify posterior tibial tendon
- Lies behind medial malleolus
- Find tendon by inverting foot against resistance
- Posterior tibial nerve lies behind tibial tendon
- Stretch, compress posterior tibial nerve
- Simultaneous dorsiflexion and eversion of foot
- Tinel's sign
- Differential Diagnosis
- Complex Regional Pain Syndrome
- Plantar Fasciitis
- Diabetic Neuropathy
- Lumbar Disc Disease (Lumbosacral Radiculopathy)
- Peripheral Neuropathy
- Posterior tibial dysfunction
- Exertional Compartment Syndrome
- Management
- Stretching program
- Medial Heel wedge or Heel Seat
- Inverts heel
- Removes traction from tibial nerve
- Orthotics to correct foot posture (e.g. pes planus)
- Tarsal Tunnel Injection
- Surgical release of entrapment
- Indicated for persistent symptoms
- References
- Del Toro in Frontera (2002) Essentials PM&R, p. 453-6
- Mann in DeLee (2003) Orthopedic Sports Med, p. 2474-6
- Shapiro (2003) Med Clin North Am 87(3):663
Structure of tarsal canal (C0225150) | |
|---|---|
| Concepts | Body Space or Junction (T030) |
| English | Structure of tarsal canal, Tarsal canal, Tarsal tunnel |
| Spanish | canal tarsiano, estructura del canal tarsiano, tunel tarsiano |
| Parent Concepts | Ankle (C0003086), Body conduit (C1735317) |
| Sources | SCTSPA, SNOMEDCT Derived from the NIH UMLS (Unified Medical Language System) |