- 355.5 Tarsal tunnel syndrome
- G57.50 Tarsal tunnel syndrome, unspecified lower limb
- 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.2
- 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
- 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 1/3 of the
plantar aspect of the 4th and 5th toes2
- The first branch of the LPN innervates the
flexor digitorum brevis, quadratus plantae, and abductor digiti
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 2/3 of the plantar aspect of the foot
- Diagnosis typically made by clinical examination
- Pathophysiology, diagnosis, and management are subject to
debate in previous and current literature.
- Tarsal tunnel syndrome symptoms may include weakness or loss
of sensation in the foot from damage to the tibial nerve.
- Often misdiagnosed as plantar fasciitis
- Occurs in 15% of adults with foot problems
- Affects males and females
- Athletic and nonathletic populations
- Pain with prolonged walking, with gradual onset associated
with weight-bearing activities
- Posteromedial ankle and foot pain, tenderness to palpation
- Possible positive Tinel sign with symptoms radiating proximal
- Sensory disturbance medial and plantar aspects of the heel
(medial calcaneal nerve)3
- Local swelling/edema over and/or beneath
- Nerve tenderness with palpation with symptoms into the longitudinal
- There may be tenderness in intertarsal spaces representative
of nerve irritability
- Weakness of foot, toes or ankle
- Weakness and/or the inability to curl the toes, push
the foot down, or twist the ankle inward
- Limitations of prolonged walking and standing
- Gait dysfunction
- Severe loss of sensation may lead to ...
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