J Korean Orthop Assoc.  2014 Oct;49(5):340-345. 10.4055/jkoa.2014.49.5.340.

Update on Management of Compressive Neuropathy: Tarsal Tunnel Syndrome

  • 1Department of Orthopedic Surgery, Korea University Guro Hospital, Seoul, Korea. dakjul@korea.ac.kr


The tarsal tunnel is located beneath the flexor retinaculum, which connects the medial malleolus and calacaneus. The tarsal tunnel contains the posterior tibialis tendon, flexor digitorum longus tendon, posterior tibial artery and vein, posterior tibial nerve, and flexor halluces longus tendon. Tarsal tunnel syndrome is a compressive neuropathy of posterior tibial nerve and its branches under the flexor retinaculum. The etiologies of tarsal tunnel syndrome are space-occupying lesion, hypertrophied flexor retinaculum, osteophytes, tarsal coalition, varicose vein, and trauma. The symptoms are foot pain and hypoesthesia or paresthesia at dermatome according to involving nerve branches. Clinical diagnosis can be obtained from a detailed history and physical examination such as compressive test at the tarsal tunnel area. Ultrasonography and magnetic resonance imaging can reveal the space-occupying lesion, such as ganglion, lipoma, and neuroma. The initial treatments of tarsal tunnel syndrome are conservative management, such as physical therapy, night splint, and steroid injection. Surgical decompression is indicated after failure of conservative managements. Variable results of surgical treatment have been reported. Favorable result after decompression could be obtained from young patients, early onset symptoms, and space-occupying lesion.


posterior tibial nerve; entrapment neuropathy; tarsal tunnel; treatment

MeSH Terms

Decompression, Surgical
Ganglion Cysts
Magnetic Resonance Imaging
Physical Examination
Tarsal Tunnel Syndrome*
Tibial Arteries
Tibial Nerve
Varicose Veins


  • Figure 1 Schematic drawing shows posterior tibial nerve and its branches under the flexor retinaculum.

  • Figure 2 Photograph of tarsal tunnel syndrome due to the space-occupying lesion. (A) Ultrasonography showed the hypoechoic signal with dotted hypeechogenecity (white arrow) at tarsal tunnel area. (B) Soft tissue tumor (black arrow) were seen after dissection. (C) Palisading hypercellular area was mixed with hypocellular area, pathologic report was schwannoma (H&E, ×100).


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