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

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

Abstract

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.

Keyword

posterior tibial nerve; entrapment neuropathy; tarsal tunnel; treatment

MeSH Terms

Decompression
Decompression, Surgical
Diagnosis
Foot
Ganglion Cysts
Humans
Hypesthesia
Lipoma
Magnetic Resonance Imaging
Neuroma
Osteophyte
Paresthesia
Physical Examination
Splints
Tarsal Tunnel Syndrome*
Tendons
Tibial Arteries
Tibial Nerve
Ultrasonography
Varicose Veins
Veins

Figure

  • 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).


Reference

1. Keck C. The tarsal-tunnel syndrome. J Bone Joint Surg Am. 1962; 44:180–182.
Article
2. Lam SJ. A tarsal-tunnel syndrome. Lancet. 1962; 2:1354–1355.
Article
3. Havel PE, Ebraheim NA, Clark SE, Jackson WT, DiDio L. Tibial nerve branching in the tarsal tunnel. Foot Ankle. 1988; 9:117–119.
Article
4. Heimkes B, Posel P, Stotz S, Wolf K. The proximal and distal tarsal tunnel syndromes. An anatomical study. Int Orthop. 1987; 11:193–196.
5. Kim JY, Lee HK, Cho J. Tarsal tunnel syndrome secondary to recurred schwannoma arising from the posterior tibial nerve. J Korean Foot Ankle Soc. 2014; 18:36–39.
Article
6. Sung KS, Park SJ. Short-term operative outcome of tarsal tunnel syndrome due to benign space-occupying lesions. Foot Ankle Int. 2009; 30:741–745.
Article
7. Ahmad M, Tsang K, Mackenney PJ, Adedapo AO. Tarsal tunnel syndrome: a literature review. Foot Ankle Surg. 2012; 18:149–152.
Article
8. Baylan SP, Paik SW, Barnert AL, Ko KH, Yu J, Persellin RH. Prevalence of the tarsal tunnel syndrome in rheumatoid arthritis. Rheumatol Rehabil. 1981; 20:148–150.
Article
9. Skalley TC, Schon LC, Hinton RY, Myerson MS. Clinical results following revision tibial nerve release. Foot Ankle Int. 1994; 15:360–367.
Article
10. Reed SC, Wright CS. Compression of the deep branch of the peroneal nerve by the extensor hallucis brevis muscle: a variation of the anterior tarsal tunnel syndrome. Can J Surg. 1995; 38:545–546.
11. Kinoshita M, Okuda R, Yasuda T, Abe M. Tarsal tunnel syndrome in athletes. Am J Sports Med. 2006; 34:1307–1312.
Article
12. Machiels F, Shahabpour M, De Maeseneer M, Schmedding E, Wylock P, Osteaux M. Tarsal tunnel syndrome: ultrasonographic and MRI features. JBR-BTR. 1999; 82:49–50.
13. Jung HJ, Lee SW, Jeong YM, et al. The usefulness of the preoperative magnetic resonance imaging findings in the evaluation of tarsal tunnel syndrome. J Korean Soc Radiol. 2012; 66:183–192.
Article
14. Lau JT, Daniels TR. Tarsal tunnel syndrome: a review of the literature. Foot Ankle Int. 1999; 20:201–209.
Article
15. Edwards WG, Lincoln CR, Bassett FH 3rd, Goldner JL. The tarsal tunnel syndrome. Diagnosis and treatment. JAMA. 1969; 207:716–720.
Article
16. Alshami AM, Babri AS, Souvlis T, Coppieters MW. Strain in the tibial and plantar nerves with foot and ankle movements and the influence of adjacent joint positions. J Appl Biomech. 2008; 24:368–376.
Article
17. Radin EL. Tarsal tunnel syndrome. Clin Orthop Relat Res. 1983; 181:167–170.
Article
18. Nekoroski T, Paladini RD, Sauder DN, Frost GI, Keller GA. A recombinant human hyaluronidase sustained release gel for the treatment of post-surgical edema. Int J Dermatol. 2014; 53:777–785.
Article
19. Reeve F, Laughlin RT, Wright DG. Endoscopic plantar fascia release: a cross-sectional anatomic study. Foot Ankle Int. 1997; 18:398–401.
Article
20. Hofmeister EP, Elliott MJ, Juliano PJ. Endoscopic plantar fascia release: an anatomical study. Foot Ankle Int. 1995; 16:719–723.
Article
21. Sammarco GJ, Chang L. Outcome of surgical treatment of tarsal tunnel syndrome. Foot Ankle Int. 2003; 24:125–131.
Article
22. Takakura Y, Kitada C, Sugimoto K, Tanaka Y, Tamai S. Tarsal tunnel syndrome. Causes and results of operative treatment. J Bone Joint Surg Br. 1991; 73:125–128.
Article
23. Bailie DS, Kelikian AS. Tarsal tunnel syndrome: diagnosis, surgical technique, and functional outcome. Foot Ankle Int. 1998; 19:65–72.
Article
24. Pfeiffer WH, Cracchiolo A 3rd. Clinical results after tarsal tunnel decompression. J Bone Joint Surg Am. 1994; 76:1222–1230.
Article
25. Bazaz R, Ferkel RD. Results of endoscopic plantar fascia release. Foot Ankle Int. 2007; 28:549–556.
Article
26. Ahn JH, Kim KJ, Kim HY, Choy WS, Yang DS. Surgical treatment of tarsal tunnel syndrome. J Korean Foot Ankle Soc. 2007; 11:187–191.
27. Franson J, Baravarian B. Tarsal tunnel syndrome: a compression neuropathy involving four distinct tunnels. Clin Podiatr Med Surg. 2006; 23:597–609.
Article
Full Text Links
  • JKOA
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr