1. Tarsal Tunnel Syndrome

2. 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

3. Pathology
Irritation of the peripheral nerve within the Tarsal Tunnel

4. 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

5. 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

6. 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

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

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

9. 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

10. Plan B
Corticosteroid Injection
Surgical decompression

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