Tarsal Tunnel Syndrome
What is it: Tarsal Tunnel syndrome involves impingement of the posterior tibial nerve beneath the flexor retinaculum in the region behind the medial malleolus.
How does it present: Patients usually complain of medial foot pain, perhaps parestheias, usually worsened by prolonged standing or walking.
Common exam findings: Excessive foot pronation may be an underlying cause. Patients may have a positive Tinel's Test at the tarsal tunnel, or tenderness in the region behind the medial malleolus.
Tests and treatment: If bony abnormalities need to be ruled out, an ankle x-ray can be ordered. Nerve Conduction studies and EMG may be helpful in diagnosis. Tarsal tunnel syndrome is usually treated with conservative measures. Orthotics may be helpful with excessive pronation, rehabilitation may also help. Surgical decompression is reserved for recalcitrant cases.