TARSAL TUNNEL SYNDROME - DNB Orthopaedics MS Orthopedics MRCS Exam GUIDE - Orthodnb.com

DNB Orthopaedics  MS Orthopedics  MRCS Exam GUIDE - Orthodnb.com

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Friday 8 June 2018



  • entrapment of tibial nerve beneath the flexor retinaculam
Anatomy and etiology
  • flexor retinaculam is the unyielding fibrous roof of the tarsal tunnel that extends from medial malleolus (posteriorly) to medial side of tuberosity of calcaneum ( inferiorly) – 2.5 to 3 cm wide with indistinct borders
  • proximal border – continuous with deep fascia of calf
  • distally – deep fascial of medial part of sole
  • septa from roof to calcaneum separate in order TP, FDL, Tibial N, Post tibial artery, accompanying veins, FHL
  • Tibial N – branches to medial and lateral plantar nerves, gives of calcaneal br. In tarsal tunnel
Constrictions related to tarsal tunnel
  • bone fragments from displaced distal tibial, talar or calcaneal #
  • tenosynovitis or ganglia of adjacent tendon sheath
  • bone and soft tissue changes in RA, Ankylosing spondylitis, Varicosities, Neural tumors, Perineural fibrosis
  • fixed valgus hind foot ( tarsal coalition) – c/c traction neuropathy
Clinical findings
  • burning/ dysthesia/ paraesthesia on plantar aspect of foot – increased by prolonged standing – dec by rest – worsening in night
  • Vallix phenomenon – proximal radiation of pain along the medial aspect of leg to mid calf
  • subtle sensory difference form other foot, local temp, sweating pattern, skin abnormalities
  • Abd hallucis, Abd Dig Minimi, atrophy
  • Tinel's sign – tenderness over tibial N at ankle
  • Provocative test : dorsiflexion, eversion of ankle, with all MTP maximally dorsiflexed
  • Electro diagnosis
    • NCV of medial and lateral plantar N
    • measurement of motor evoked potentials
    • measurement of sensory conduction velocity
  • MRI – to identify the cause – visualize the tarsal tunnel and distal br of tibial N
  • X ray, CT
  • conservative
    • NSAID
    • local steroid injection for tenosynovitis
    • orthotics for flexible foot deformity
  • Surgical
    • Tarsal tunnel release

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