tarsal tunnel syndrome (posterior tibial neuropathy)

Introduction

Entrapment of the posterior tibial nerve in its 3rd compartment of the flexor retinaculum tunnel just posterior to the medial malleolus. Also see carpal tunnel syndrome.

Etiology

• fracture involving the tarsal tunnel
• ganglion in the adjacent tendon sheath
• lipoma
• severe pronation (flat foot) with secondary stretch of the posterior tibial nerve

Clinical manifestations

• paresthesias in the arch of the foot
• numbness of the toes
• proximal & medial radiation of pain may occur into the leg
• symptoms are aggravated by activity
• positive Tinel's sign with pain after percussion over the region of the posterior tibial nerve

Management

also see carpal tunnel syndrome

• non-steroidal anti-inflammatory agents (NSAIDs)
• hind foot orthoses to limit pronation of the heel & stretching of the posterior tibial nerve
• corticosteroid injections give variable results
• surgical release of the entire tarsal tunnel

More general terms

• entrapment neuropathy; nerve entrapment syndrome; pinched nerve

Additional terms

• carpal tunnel syndrome (median neuropathy)
• paresthesia; burning; tingling
• posterior tibial nerve
• Tinel's sign