PREFERRED PRACTICE PATTERNS
4E: Impaired Joint Mobility, Motor Function, Muscle Performance, and Range of Motion Associated with Localized Inflammation
5F: Impaired Peripheral Nerve Integrity and Muscle Performance Associated with Peripheral Nerve Injury
A 27-year-old male recreational runner/jogger presents with right ankle and foot pain and numbness of 2 weeks duration. The patient reports spraining his ankle 6 months ago when he turned his ankle inward while jogging on an uneven surface. He sustained a sprain to his medial ankle that resolved uneventfully in 2 to 3 weeks. Upon returning to running/jogging, the patient noted stiffness and generalized right lower-extremity weakness but denied ankle or leg pain. Patient reports that he returned to his typical jogging mileage of more than 35 miles/week with 2 weeks of return to jogging. At this time, he reports medial ankle and foot paresthesia/numbness beneath his medial malleolus that travels into the medial arch and plantar aspect of his foot and heel. Numbness/paresthesia is increased shortly after initiating jogging and is notable with standing and walking, especially if the patient wears sandals or flip-flops. Upon palpation, the patient reports pain and tenderness inferior to his medial malleolus. The patient has a positive Tinel sign with testing inferior to medial malleolus. Weakness noted for flexion of the big toe.
Tarsal tunnel syndrome is an entrapment syndrome of the tibial nerve behind (posterior to) the medial malleolus and under the flexor retinaculum or laciniate ligament.1
Structures that pass through the tarsal tunnel
Flexor hallucis longus muscle
Flexor digitorum longus muscle
Tibialis posterior muscle
Posterior tibial nerve
Posterior tibial artery
The tibial nerve supplies movement and sensation to the calf and foot muscles.
The deep and superficial aponeuroses of the leg form the laciniate ligament, which is closely attached to the sheath of the three adjacent flexor tendons, the posterior tibial, the flexor digitorum, and flexor hallucis.1
Tarsal tunnel is a peripheral neuropathy that occurs when there is damage to the tibial nerve, one of the lower branches of the sciatic nerve of the leg.
Nerve entrapment sites, branches of tibial nerve:
Lateral plantar nerve (LPN): Supplies most of the foot muscles and the skin of the lateral one-third of the plantar aspect of the fourth and fifth toes.2
Medial calcaneal nerve: Sensory innervations to heel fat pad and superficial tissues over the inferior aspect of the calcaneus.
Medial plantar nerve: Innervations of abductor hallucis, flexor hallucis brevis, flexor digitorum brevis, first lumbrical, and skin of the medial ...
Log In to View More
If you don't have a subscription, please view our individual subscription options below to find out how you can gain access to this content.
Want remote access to your institution's subscription?
Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.
If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.
AccessPhysiotherapy Full Site: One-Year Subscription
Connect to the full suite of AccessPhysiotherapy content and resources including interactive NPTE review, more than 500 videos, Anatomy & Physiology Revealed, 20+ leading textbooks, and more.
Pay Per View: Timed Access to all of AccessPhysiotherapy
24 Hour Subscription $34.95
48 Hour Subscription $54.95
Pop-up div Successfully Displayed
This div only appears when the trigger link is hovered over.
Otherwise it is hidden from view.