Tarsal tunnel syndrome

1. TARSAL TUNNEL
SYNDROME
SUHAIL A P

2. INTRODUCTION
 Compression neuropathy of posterior
tibial nerve
 TARSAL TUNNEL – contents
◦ tibialis posterior
◦ Flexor digitorum longus
◦ Posterior tibial artery and vein
◦ POSTERIOR TIBIAL NERVE
◦ Flexor hallucis longus

3.  Posterior tibial nerve – medial plantar
nerve, lateral plantar nerve, calcaneal
br.

4. CLINICAL FEATURES
 Most common in middle aged females
 Pain and burning sensation- localised
posterior and inferior to medial
malleolus
 Numbnes
 Pain worsens with activity and later
rest pain

5.  No local signs of inflammation
 Point tenderness over soft spot on
medial border of ABDUCTOR
HALLUCIS
 VALLEIX Test positive
 Tinels sign +
 Two point discrimination

6. Point tenderness over the soft spot on the
medial border of the abductor hallucis.

7. ETIOLOGY
 INTRINSIC FACTORS
 Tendonopathies
 Osteophytes
 Accessory muscles
 Ganglia
 Lipomas

8.  EXTRINSIC FACTORS
 Trauma
 Foot malformations
 Constrictive footwear
 Oedema
 Iatrogenic TTS

9. DIAGNOSIS
 Clinical diagnosis
 Tinels test
 Dorsiflexion eversion test
 Valleix test
 X ray
 MRI
 MRN
 US
 EMG
 NCS

11. Treatment
 NON OPERATIVE
 Activity modification
 Medications – NSAIDS and
Gabapentin
 Nerve mobilisation excercises
 Night Splints
 Orthotic inserts

12.  OPERATIVE
Curved medial incion over tarsal
tunnel
Release of Post Tibial Nerve in TT
Success rate -71%