J Korean Foot Ankle Soc.  2023 Dec;27(4):158-161. 10.14193/jkfas.2023.27.4.158.

Tarsal Tunnel Syndrome due to Varicose Veins Misdiagnosed as Ganglion Cyst: A Case Report

  • 1Department of Orthopaedic Surgery, Wonkwang University Sanbon Hospital, Wonkwang University School of Medicine, Gunpo, Korea


Tarsal tunnel syndrome is a nerve entrapment syndrome of posterior tibial nerve as it passes through the tarsal tunnel. The patient presented posteromedial malleolar swelling, palpable mass and pain, and was misdiagnosed as ganglion cyst in the other clinic. Aspiration and steroid injection were done for years, which had no significant effect on symptom relief. As skin lesion and pigmentation abruptly appeared around the palpable mass, MRI and physical exam were done in our hospital. The patient was diagnosed as varicose veininduced tarsal tunnel syndrome and therefore tarsal tunnel decompression following dilatated varicose vein resection was done. The patient’s symptom was improved after the surgery. Therefore, herein we report this case.


Tarsal tunnel syndrome; Varicose veins; Ganglion cyst


  • Figure 1 Preoperative clinical photograph. Skin change and pigmentation occurred in posteromedial malleolar (arrow).

  • Figure 2 Magnetic resonance imaging scan. (A) T1-weighted coronal. (B) T1-weighted fat suppression with contrast coronal. Abnormally protruded superficial vein (upper arrowheads) in posteromedial malleolar was found, which had been visually considered as ganglion cyst. Varicosity of posterior tibial vein (lower arrowheads) extended to tarsal tunnel, compressing tibial nerve (arrows).

  • Figure 3 Magnetic resonance imaging scan. (A) T1-weighted sagittal. (B) T1-weighted fat suppression with contrast sagittal. Varicosity of posterior tibial vein (arrowheads) extended to tarsal tunnel, causing venous engorgement and tibial nerve (arrows) compression.

  • Figure 4 Intraoperative photograph. Posterior tibial nerve (arrows) was compressed by varicose vein (arrowheads).

  • Figure 5 Gross specimen photograph. Posterior tibial vein and superficial vein were removed.



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