T

ICD-9-CM Code

• 355.5 Tarsal tunnel syndrome

ICD-10-CM Code

• G57.50 Tarsal tunnel syndrome, unspecified lower limb

Preferred Practice Patterns1

• 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

Key Features

Description

• 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 flexor hallucis1
• 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 minimi.
  • 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 2/3 of the plantar aspect of the foot

Essentials of Diagnosis

• 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.

General Considerations

• Often misdiagnosed as plantar fasciitis

Demographics

• Occurs in 15% of adults with foot problems
• Affects males and females
• Athletic and nonathletic populations

Clinical Findings

Signs and Symptoms

• Pain with prolonged walking, with gradual onset associated with weight-bearing activities
• Posteromedial ankle and foot pain, tenderness to palpation posteromedial heel
• Possible positive Tinel sign with symptoms radiating proximal or distal.
• Sensory disturbance medial and plantar aspects of the heel (medial calcaneal nerve)3
• Local swelling/edema over and/or beneath the retinaculum
• Nerve tenderness with palpation with symptoms into the longitudinal arch
• There may be tenderness in intertarsal spaces representative of nerve irritability
• Weakness of foot, toes or ...