The most common symptoms are pain and paresthesia in the toes, sole, or heel and the main finding at physical examination is the Tinel sign (distal paresthesias produced by percussion over the affected portion of nerve). Tarsal tunnel syndrome is usually unilateral.
Electromyography and nerve conduction studies are useful in confirming the diagnosis.
Because the tarsal tunnel is a tight space, volume-occupying lesions can cause symptoms.
- idiopathic (50% cases) 1
- ganglion cysts
- bone deformity after calcaneal fractures
- tenosynovitis of the flexor tendons
- tumours (e.g. neurilemmoma 6, lipoma)
- accessory or hypertrophied abductor hallucis muscle
- synovial hypertrophy
- hindfoot valgus 1
- post-traumatic fibrosis
- os trigonum 2
May be able to demonstrate the presence of some of the aetiological factors listed above.
MR imaging clearly depicts the bones, soft-tissue contents, and boundaries of the tarsal tunnel as well as the different pathologic conditions responsible for tarsal tunnel syndrome.
MR imaging can also aid in determining whether treatment should be conservative (e.g. tenosynovitis) or surgical (e.g. space-occupying lesions).
History and etymology
The term was first specifically described by C Keck and S J S Lam in 1962 3.
Treatment and prognosis
Conservative management - orthosis, local injection, anti-inflammatory medications, and tricyclic antidepressants (TCA).
Surgical management - decompressive surgery.
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- 2. Rosenberg ZS, Beltran J, Bencardino JT. From the RSNA Refresher Courses. Radiological Society of North America. MR imaging of the ankle and foot. Radiographics. 2000;20 Spec No : S153-79. Radiographics (link) - Pubmed citation
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- 4. Fantino O, Coillard JY, Borne J et-al. Ultrasound of the tarsal tunnel: Normal and pathological imaging features. J Radiol. 2011;92 (12): 1072-80. doi:10.1016/j.jradio.2011.03.026 - Pubmed citation
- 5. Fantino O. Role of ultrasound in posteromedial tarsal tunnel syndrome: 81 cases. J Ultrasound. 2014;17 (2): 99-112. doi:10.1007/s40477-014-0082-9 - Free text at pubmed - Pubmed citation
- 6. Boya H, Ozcan O, Oztekin HH. Tarsal tunnel syndrome associated with a neurilemoma in posterior tibial nerve: a case report. Foot (Edinb). 2008;18 (3): 174-7. doi:10.1016/j.foot.2008.05.006 - Pubmed citation