Tarsal Tunnel Syndrome: Diagnosis and Management

Abstract

Tarsal tunnel syndrome refers to neuralgia of the tibial nerve or any of its terminal branches within the tarsal tunnel of the ankle. Often, this syndrome refers to a compression or entrapment neuropathy, but it may also be secondary to a neurapraxia. Tarsal tunnel syndrome may be caused by space-occupying lesions, trauma, deformity, and malalignment of the lower extremity. However, a specific cause for tarsal tunnel syndrome is found in only 60% to 80% of patients. Treatment of tarsal tunnel syndrome is patient-specific, depending on the underlying etiology. Nonsurgical management includes the use of anti-inflammatory medications and other medications used for neuralgia. Braces, including foot orthoses, stirrup braces, prefabricated ankle-foot orthoses, and boot braces, can be effective as a mechanical first-line treatment. When nonsurgical options fail to relieve symptoms, or when there is a specific surgical indication, surgical procedures, including nerve decompression and release, surgical excision of a compressive lesion, and deformity correction, may be useful. This article highlights the diagnosis and work-up of patients with tarsal tunnel syndrome, and describes the technique for decompression of the tarsal tunnel through release of the tibial nerve and its associated branches.

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