Overview
Tarsal tunnel syndrome (TTS) is a compression neuropathy of the posterior tibial nerve or its branches within the tarsal tunnel, leading to symptoms such as dysesthesia, paresthesia, and pain in the foot, particularly around the medial plantar aspect 13.Diagnosis
Clinical Presentation: Intermittent dysesthesia, paresthesia, or anesthesia in the medial plantar aspect of the foot, exacerbated by activity 3.
Physical Examination: Positive Tinel's sign is common 23.
Imaging: Magnetic Resonance Imaging (MRI) is useful for identifying nerve compression due to mass lesions or idiopathic factors but may not detail specific causes like varices or small vessel branches 15.
Diagnostic Imaging Limitations: MRI can localize compression but may miss specific etiologies like varicosities and small vessel strangulation 1.Management
Surgical Decompression: Recommended for longstanding cases where conservative measures fail; involves releasing entrapped nerve from fascial septa, varicosities, scar tissues, or other compressive elements 3.
Conservative Management: Initial treatment may include rest, immobilization, physical therapy, and nonsteroidal anti-inflammatory drugs (NSAIDs) for pain and inflammation 3.
Follow-Up: Clinical follow-up post-surgery typically shows symptom relief within 1 year in 61% of patients 3.Special Populations
Elderly: Older patients (mean age 74.5 years) may present with idiopathic TTS predominantly, with MRI aiding in diagnosis but having limitations in surgical planning 1.
Comorbidities: Previous trauma can complicate outcomes, with some patients experiencing persistent severe pain post-surgery 3.Key Recommendations
Use MRI for Initial Diagnosis: MRI is valuable for identifying nerve compression sites but may not specify all etiologies; consider surgical exploration for definitive diagnosis and treatment 15 (Evidence: Moderate).
Surgical Intervention for Chronic Cases: Decompressive surgery is effective in relieving symptoms in longstanding TTS, with positive outcomes in 61% of patients 3 (Evidence: Moderate).
Evaluate for Specific Etiologies: Given MRI limitations, surgical exploration may be necessary to identify specific causes like varicosities or connective tissue entrapment 13 (Evidence: Weak).References
1 Kim K, Kokubo R, Isu T, Nariai M, Morimoto D, Kawauchi M et al.. Magnetic Resonance Imaging Findings in Patients with Tarsal Tunnel Syndrome. Neurologia medico-chirurgica 2022. link
2 Pasku DS, Karampekios SK, Kontakis GM, Katonis PG. Varicosities as an etiology of tarsal tunnel syndrome and the significance of tinel's sign: report of two cases in young men and a review of the literature. Journal of the American Podiatric Medical Association 2009. link
3 Turan I, Rivero-Melián C, Guntner P, Rolf C. Tarsal tunnel syndrome. Outcome of surgery in longstanding cases. Clinical orthopaedics and related research 1997. link
4 Zahari DT, Ly P. Recurrent tarsal tunnel syndrome. The Journal of foot surgery 1992. link
5 Kerr R, Frey C. MR imaging in tarsal tunnel syndrome. Journal of computer assisted tomography 1991. link
6 Adelman KA, Wilson G, Wolf JA. Anterior tarsal tunnel syndrome. The Journal of foot surgery 1988. link
7 Gould N, Alvarez R. Bilateral tarsal tunnel syndrome caused by varicosities. Foot & ankle 1983. link
8 Kaye JJ, Ghelman B, Schneider R. Talocalcaneonavicular joint arthrography for sustentacular-talar tarsal coalitions. Radiology 1975. link