Overview
Entrapment of the common peroneal nerve, particularly within the anterior tarsal tunnel, results in chronic irritation or compression leading to symptoms affecting the foot and lower leg. This syndrome is characterized by abnormal stretch or compression of the deep peroneal nerve, often under-recognized in clinical practice 12.Diagnosis
Clinical Presentation: Pain, numbness, or weakness in the foot, particularly affecting dorsiflexion and toe extension 12.
Physical Examination: Tinel's sign over the anterior tarsal tunnel, weakness in eversion of the foot, and diminished sensation over the dorsum of the foot 12.
Diagnostic Imaging: Ultrasound or MRI may help visualize nerve compression or anatomical abnormalities 2.
Electromyography/Nerve Conduction Studies: Useful for confirming nerve dysfunction and localization 2.Management
Conservative Treatment: Rest, immobilization with a brace or splint, and physical therapy focusing on stretching and strengthening exercises 2.
Medication: Nonsteroidal anti-inflammatory drugs (NSAIDs) for pain and inflammation management 2.
Injections: Corticosteroid injections may provide temporary relief by reducing local inflammation 2.
Surgical Intervention: Considered for refractory cases where conservative measures fail, involving decompression of the nerve 2.Special Populations
Pregnancy: No specific data provided; conservative management is typically recommended due to pregnancy-related anatomical changes 2.
Elderly: Conservative approaches are favored due to increased surgical risks; careful assessment of comorbidities is essential 2.Key Recommendations
Confirm Diagnosis with Physical Examination and Electrophysiological Studies: Utilize clinical signs and nerve conduction studies for accurate diagnosis (Evidence: Moderate 2).
Initiate Conservative Management Including Physical Therapy and NSAIDs: Prioritize non-invasive treatments before considering more aggressive interventions (Evidence: Moderate 2).
Consider Surgical Decompression for Persistent Symptoms Unresponsive to Conservative Measures: Evaluate surgical options cautiously in cases where conservative treatments fail (Evidence: Expert opinion 2).References
1 Borges LF, Hallett M, Selkoe DJ, Welch K. The anterior tarsal tunnel syndrome. Report of two cases. Journal of neurosurgery 1981. link
2 Kuritz HM. Anterior entrapment syndromes. The Journal of foot surgery 1976. link