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Inferior heel pain
Published in Maneesh Bhatia, Essentials of Foot and Ankle Surgery, 2021
Dishan Singh, Shelain Patel, Karan Malhotra
Tarsal tunnel syndrome is a condition where the posterior tibial nerve or its branches become compressed. The tarsal tunnel contains the tibialis posterior, flexor digitorum longus, posterior tibial artery and veins, tibial nerve, and flexor hallucis longus. These structures run in a fibro-osseous tunnel from the medial malleolus to the midfoot. From proximal to distal the ‘floor’ of the tunnel is formed by the posterior aspect of the medial malleolus, the talus, the sustentaculum tali and the calcaneal body. Proximally, the ‘roof’ of the tunnel is formed by the flexor retinaculum. At its termination the tarsal tunnel narrows and merges with the fascia of the abductor hallucis muscle. The tibial nerve lies posterior to the artery and branches into the medial and lateral plantar nerves and the medial calcaneal nerve. This trifurcation has a variable location, but usually occurs proximal to or within the tarsal tunnel. The medial and lateral plantar branches enter the foot deep to the abductor hallucis (Figure 10.6).
Diseases of the Peripheral Nerve and Mononeuropathies
Published in Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw, Hankey's Clinical Neurology, 2020
Diana Mnatsakanova, Charles K. Abrams
Tarsal tunnel syndrome: Usually unilateral, burning pain in sole of foot.Symptoms may only be present at night or while exercising.May have atrophy of intrinsic foot muscles.Sensory loss in the sole of the foot and toes in the distribution of the medial plantar nerve (most commonly), lateral plantar nerve, or both.Often, idiopathic tarsal tunnel syndrome occurs in the setting of polyneuropathy.
The ankle and foot
Published in David Silver, Silver's Joint and Soft Tissue Injection, 2018
Tarsal tunnel syndrome. This is an uncommon condition of posterior tibial nerve entrapment as it passes under the flexor retinaculum, and is analogous to the carpal tunnel syndrome of the wrist. The patient will complain of paroxysmal paraesthesia, numbness and pain along the medial border of the foot, the great toe and the distal part of the sole.
Venous malformation as source of a tarsal tunnel syndrome: treat the source or the cause of the complaints? A case report
Published in Acta Chirurgica Belgica, 2018
H. Mufty, G. A. Matricali, S. Thomis
Tarsal tunnel syndrome (TTS) is an entrapment neuropathy, caused by compression of the tibial nerve or its branches within its fibro-osseous tunnel [1]. Possible causes are divided into idiopathic, intrinsic and extrinsic groups. Neurovascular compression of venous etiology is a rare but underestimated entity [2]. If a venous cause of TTS is identified, most of the time, it concerns varicose veins [3]. Pain over the tarsal tunnel is the dominating symptom, which may or may not be accompanied by sensory symptoms [1]. Conservative management including anti-inflammatory drugs and activity is the standard of care [4]. Only in cases where symptoms do not respond to conservative therapy, surgical management can be considered [5].
Management of acute lesser toe pain
Published in Postgraduate Medicine, 2021
Jessyca Ray, Nicholas A. Andrews, Aseel Dib, Whitt M. Harrelson, Ankit Khurana, Maninder Shah Singh, Ashish Shah
All patients should undergo a brief neurologic examination including lower extremity reflexes, muscle strength, large and small fiber testing. Commonly, patients with peripheral neuropathy will be encountered and these patients will show signs of reduced lower extremity sensation and reflexes along with a possible positive Romberg sign or a high stepping gait. Patients who demonstrate upper motor signs with bladder or bowel involvement not explained by any previous diagnosis should be urgently evaluated for spinal cord, brainstem, or brain lesions. Other neurologic disorders can be divided based on their distributions and areas affected into polyneuropathies (Large fiber stocking-glove deficit pattern), lumbar radiculopathies or lumbosacral plexus lesions (Dermatomal pain distribution, proximal and distal muscle weakness, and abnormal reflexes ± low back pain), mono-neuropathies (Sensory deficits in the distribution of a peripheral nerve with isolated distal or proximal muscle weakness), or focal structural causes of nerve deficits. One such focal structural nerve disorder that affects the foot and lesser toe region is tarsal tunnel syndrome. This condition occurs due to the entrapment of the tibial nerve within the tarsal tunnel, and patients will classically have a positive Tinel’s sign defined as reproduction of their symptoms when the tibial nerve is tapped along the posterior part of the medial malleolus. If abnormalities arise in the brief neurological exam, then further neurological testing is warranted including potential radiographic imaging studies, nerve conduction studies, or even skin biopsy if small fiber neuropathy is suspected in the presence of normal conduction studies.