Tarsal Tunnel Syndrome

Question 1

What is tarsal tunnel syndrome?

Answer 1

The tibial nerve or one its branches (medial/lateral plantar or calcaneal) is entrapped under the flexor retinaculum.

Question 2

What is the MOI for tarsal tunnel syndrome?

Answer 2

Most often insidious onset. Can be caused by repetitive stress of space occupying lesions (ex. tendinitis w/in sheath).

Question 3

What subjective symptoms might a patient with tarsal tunnel syndrome report?

Answer 3

i) numbness, parasthesias etc. of the medial ankle and foot

ii) weakness in the plantar foot muscles

Question 4

What precautions exist with tarsal tunnel sydrome?

Answer 4

i) may not have adequate sensation for EPA
ii) sensory changes may affect balance
iii) skin checks at the feet

Question 5

What postural abnormality might you expect in someone with tarsal tunnel syndrome?

Answer 5

Rests in pronation/overpronates (possible former injury).

Question 6

What outcome measure is indicated in tarsal tunnel syndrome?

Answer 6

Foot and Ankle Disability Index.

Question 7

What are 5 key objective test to help determine the presence of tarsal tunnel syndrome and what are the expected findings?

Answer 7

i) ROM: limited DF and eversion (tensions tibial n.)
ii) MMT: weak toe abductors and flexors
iii) Dorsiflexion-eversion test: reproduction of symptoms that can ascend into thigh.
iv) Tinel’s: reproduction of symptoms
v) Triple Compression Test: reproduction of symptoms

Question 8

Why would flexion of the great toe reproduce symptoms in tarsal tunnel syndrome?

Answer 8

FHL also travels within the tarsal tunnel and compresses the tibial nerve when tense.

Question 9

What are three differential diagnoses for tarsal tunnel syndrome and how would you rule them out?

Answer 9

i) Plantar fasciitis: quality of pain, Windlass test would painful and tight
ii) FHL tendinopathy: quality of pain, localization of symptoms
iii) L5/S1 radiculopathy: L/S ROM may reproduce symptoms, myotomes/dermatomes, diminished reflex