Orthopedics Book

http://www.fpnotebook.com/

Posterior Tarsal Tunnel SyndromeAka: Tarsal Tunnel, Tibial Neuropathy, Posterior Tibial Nerve Entrapment

Advertisement

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

Structure of tarsal canal (C0225150)

ConceptsBody Space or Junction (T030)
EnglishStructure of tarsal canal, Tarsal canal, Tarsal tunnel
Spanishcanal tarsiano, estructura del canal tarsiano, tunel tarsiano
Parent ConceptsAnkle (C0003086), Body conduit (C1735317)
SourcesSCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)



Navigation Tree