Tarsal Tunnel Syndrome

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Presentation transcript:

Tarsal Tunnel Syndrome

Normal Anatomy Tibial nerve is the medial component of the sciatic nerve Tibial nerve comes to the surface at the level of the medial side of the ankle Enters the tarsal tunnel between the medial malleolus and achilles tendon with the posterior tibial artery and vein Tarsal Tunnel is an osteofibrous canal covered by the flexor retinaculum Tibial nerve splits in the Tarsal Tunnel into the medial and lateral plantar nerves

Pathology Irritation of the peripheral nerve within the Tarsal Tunnel

Mechanism of Injury Insidious Traumatic Space occupying lesions Repetitive stress through running or walking Muscle and Tendon Hypertrophy Excessive weight Rheumatoid Arthritis Traumatic Fractures Dislocation Ligament sprains

Subjective Examination Tingling or numbness around the medial ankle and plantar surface of the foot Pain with prolonged standing or walking Burning sensation at night

Objective Examination Pain on palpation of the nerve on the medial ankle Painful sustained dorsiflexion plus eversion Loss of sensation medial aspect of the foot Reduced power of the toe abductors and flexors Percussion of posterior tibial nerve causes paraesthesia

Further Investigation Electrophysiological testing (Nerve Conduction Velocity testing) X-ray MRI

Management Goal of management to reduce the compression within the tarsal tunnel

Conservative Reduce pain and inflammation Ice NSAID’s Orthotics Night Splints Taping Massage Restore Normal Range of Movement Ankle and Foot Soft tissue massage Foam rolling Stretching Dry needling Joint mobilisations Joint manipulations Neurodynamic mobilisations Restore Normal Muscle Activation Intrinsic foot muscles

Plan B Corticosteroid Injection Surgical decompression

References Ahmad, M., K. Tsang, P. J. Mackenney and A. O. Adedapo (2012). "Tarsal tunnel syndrome: A literature review." Foot Ankle Surg 18(3): 149-152. Antoniadis, G. and K. Scheglmann (2008). "Posterior Tarsal Tunnel Syndrome: Diagnosis and Treatment." Dtsch Arztebl Int 105(45): 776- 781. Hudes, K. (2010). Conservative management of a case of tarsal tunnel syndrome. J Can Chiropr Assoc. 54: 100-106.