Hypertrophic sustentaculum tali causing a tarsal tunnel syndrome: a case report.

A case report of tarsal tunnel syndrome caused by a hypertrophic sustentaculum tali is presented. This is the first reported case secondary to this etiology. Complete resolution of the patient's symptoms has been obtained through resection of the hypertrophic anatomy. The authors also discuss possible etiologies of tarsal tunnel syndrome.     

A ganglion causing the tarsal tunnel syndrome: report of a case.

The tarsal tunnel syndrome is a complex of symptoms affecting the foot produced by compression neuropathy of the posterior tibial nerve on the medial aspect of the ankle, within the fibrous osseous "tunnel" that has the posteromedial aspect of the tibia as its floor and the flexor retinaculum as its roof. Keck first drew attention to this entity in 1962, and was followed by Lam in the same year. Despite sporadic reports following these documentations, the clinical recognition of the syndrome is often delayed. It is still frequently misdiagnosed as acute foot strain or plantar fasciitis at its initial presentation (Kopell and Thompson, 1963; Lam, 1962, 1967). In this paper we report a case of tarsal tunnel syndrome caused by compression of the posterior tibial nerve by a ganglion at the ankle.     

The surgical treatment of tarsal tunnel syndrome

Tarsal tunnel syndrome is an entrapment neuropathy involving the posterior tibial nerve within the tarsal canal. Typical symptoms include burning pain and paraesthesia along the medial ankle and plantar aspect of the foot. Although potential causes of tarsal tunnel syndrome include trauma, varicosities, tenosynovitis, space-occupying lesions, and hindfoot deformity, in most cases the aetiology is idiopathic. Surgical release of the posterior tibial nerve and its terminal branches is indicated if symptoms persist despite non-operative treatment. In this article, we discuss the pre-operative evaluation of these patients and illustrate in detail our preferred technique for surgical release.     

The tarsal tunnel syndrome and its surgical decompression

This article addressed the tarsal tunnel syndrome. Its etiology, symptomatology, diagnosis, treatment, and surgical decompression were discussed.     

Accessory flexor digitorum longus presenting as tarsal tunnel syndrome: a case report

The flexor digitorum accessory longus (FDAL) muscle is one of the most commonly encountered anomalous muscles in the foot and ankle. Literature has documented the prevalence of the FDAL anywhere from 4% to 12%, based on cadaveric limb dissection. The variability of the origin, insertion, size, and location of the FDAL muscle can cause a wide array of foot and ankle pathologies, most notably, tarsal tunnel syndrome and flexor hallucis longus syndrome. Accessory musculature should be included in the list of differential diagnoses for foot and ankle pain until proven otherwise. This report presents a patient who exhibited pain localized to the medial malleolar region and was initially diagnosed with likely tarsal tunnel syndrome. On magnetic resonance imaging, a FDAL muscle was identified and shown to be impinging on the posterior medial anatomic structures. The patient underwent excision of the FDAL and is symptom free to date. The discussion of this case report can prompt foot and ankle surgeons to be more aware of this infrequent finding as well as treatment options. Level of Evidence: Therapeutic, Level IV.     

A rare case of an accessory flexor hallucis longus causing tarsal tunnel syndrome

Tarsal tunnel syndrome (TTS) is a rare entrapment neuropathy of the tibial nerve within the fibro-osseous tarsal tunnel for which multiple etiologies, including trauma, congenital foot abnormalities and space occupying lesions, have been described. We present an unusual case of TTS caused by an accessory Flexor Hallucis Longus (FHL) tendon. Surgical excision led to a complete resolution of symptoms and improved the quality of life of our patient.     

Results of surgical treatment of tarsal tunnel syndrome

PurposeThe purpose of this study is to present our results after surgical treatment of patients suffering from a tarsal tunnel syndrome.Material and methodsIn 75 patients 77 surgical decompressions of the tarsal tunnel were performed. All patients were treated conservatively for at least 6 months prior to surgical intervention. A positive local anesthesia test prior to the operation was mandatory for all patients. The results were evaluated according to pain at rest, pain during walking, weakness, and according to a modified AOFAS forefoot score.ResultsFollow-up ranged from 6 to 100 months (average 39 months). Only 43 out of 75 patients were subjectively satisfied and would undergo the procedure again. While pain at rest decreased in 53 patients, pain during walking decreased only in 22 cases. Subjective muscle weakness decreased in six patients—however, this parameter was not a clinical relevant problem in most of the patients. At the time of follow-up the modified AOFAS score was 44 (range 15–75).Clinical relevanceSurgical decompression of the tibial nerve did not lead to good results in all cases. Therefore the indications for surgery should be handled with strong restriction.     

Conservative management of a case of tarsal tunnel syndrome

Objective:

This case study was conducted to evaluate the treatment and management of a patient presenting with chronic foot pain, diagnosed as tarsal tunnel syndrome.

Case:

61 year old female presenting with plantar and dorsal foot pain and burning sensation of 6 months duration.

Treatment:

Treatment was initiated using custom orthotics only for the first ten weeks of care as the patient did not follow up or initially respond to follow up calls placed by the practitioner. A course of high-velocity, low-amplitude adjustments using a toggle board to the cuboid and the talonavicular joint and fascial stripping was added upon report from the patient that the orthotic therapy alone did not resolve the symptoms. Improvement of pain reported on the Verbal Rating Scale was noted with a complete resolution of the condition at the conclusion of treatment. No pain was reported on a ten month follow up with the patient.

Conclusion:

Conservative management, including orthotics, manipulation, and fascial stripping may be beneficial in the treatment of tarsal tunnel syndrome.     

Outcome of surgical treatment of tarsal tunnel syndrome

One hundred and eight ankles in 72 patients were evaluated from July 1986 to July 1997 with clinical findings and positive electrodiagnostic studies of tarsal tunnel syndrome. Clinical data included physical findings, subjective complaints, duration of symptoms, trauma history, steroid injections, nonsteroidal use and workman's compensation involvement. Associated medical conditions included diabetes, back pain and arthritis. Sixty-two patients underwent tarsal tunnel release, with 13 of them bilateral. There were 44 females and 18 males, 35 right feet and 40 left feet. The average age was 49 years. Preoperative symptom duration was 31 months. Average length of follow-up was 58 months. Average time for return to usual activity was nine months. All patients had at least a 12-month follow-up, and compared with both (Maryland Foot Score) MFS and AOFAS postoperative scores. Preoperative MFS scores obtained prior to 1994, were 61/100 (average), and postoperative MFS scores were 80/100 (average). Postoperative AOFAS scores were 80/100 (average). Patients with symptoms less than one year had postoperative MFS/AOFAS scores significantly higher than those with symptoms greater than one year. The most common surgical findings included arterial vascular leashes indenting the nerve and scarring about the nerve. Varicosities and space occupying lesions were present also. The outcome of surgery was not affected by the presence or absence of trauma. Patients with tarsal tunnel syndrome warrant surgery when significant symptoms do not respond to conservative management. Meticulous surgical technique must be followed. Improvement in foot scores is predictable even when a discrete space-occupying lesion is not present and when symptoms have been present for periods of greater than one year.     

The tarsal tunnel syndrome: evaluation of surgical results using multivariate analysis

Summary. Thirty-four patients with the tarsal tunnel syndrome were treated by decompression of the posterior tibial nerve. The condition was bilateral in 3 cases. There were 9 men and 25 women with an average age at operation of 41 years. The average follow up was for 3.8 years. Multivariate analysis showed that the outcome is influenced, in order of importance, by fibrosis around the nerve, the preoperative severity of the condition, a history of sprained ankle, worker’s compensation, a long history, and heavy work. The results were favourable when there was a short history, the presence of a ganglion, no sprains, and light work. Measurement of the terminal latency of the medial plantar nerve was valuable in assessing recovery. The precise cause of the syndrome and its effect on treatment should be considered before operation.

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Résumé. Nous rapportons ici les résultats des décompression chirurgicales du tunnel tarsien. Trente-sept nerfs tibiaux avaient été décomprimés sur trente-quatre patients (9 hommes et 25 femmes), dont la moyenne d’age était de 41 ans. L’intervalle moyen des examens de contr?le était de 3,8 ans. D’après les analyses des multiviariables il appara?t que les résultats sont affectés dans l’ordre: par des fibroses autour du nerf, la gravité de la maladie avant l’opération, des entorses de la cheville, des indemnités sociales, des antécédents pathologiques de longue date, et des travaux pénibles. Inversement les résultats sont favorables dans le cas d’un kyste du ganglion, d’absence de facteurs antérieurs et de travail physique peu pénible. La mesure de la latence finale du nerf plantaire médian a fait ressortir des valeurs significatives pour l’évolution du syndrome du tunnel tarsien.

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Accepted: 29 June 1996     

Tibial osteochondroma causing foot pain mimicking tarsal tunnel syndrome: A case report

Nerve entrapment syndromes of the lower extremity are relatively rare in patients with multiple hereditary osteochondromatosis. A case of tarsal tunnel like symptoms in a 52-year-old woman with a distal tibial osteochondroma is presented. This case emphasizes that the possibility of nerve compression needs to be considered in a patient with multiple hereditary osteochondromatosis and that tibial osteochondromas can be a cause of tarsal tunnel-like symptoms.     

Acute tarsal tunnel syndrome following partial avulsion of the flexor hallucis longus muscle: a case report.

An acute posterior tibial nerve compression from a partially ruptured flexor hallucis longus (FHL) muscle is reported. This etiology for acute tarsal tunnel syndrome has not been previously described. A 17-year-old male sustained multiple injuries in a motor vehicle accident, including a tibial shaft fracture and a posterior medial right ankle laceration of the same limb. The injured limb had no sensation on the plantar aspect of the foot and heel, decreased active great toe flexion, and associated leg pain. Exploration of the posterior tibial nerve for presumed laceration revealed the nerve to be intact, but compressed in a tense tarsal tunnel from a retracted partially ruptured flexor hallucis longus tendon. Decompression of the tunnel and resection of the devascularized muscle resulted in complete neurologic recovery.     

Tarsal tunnel syndrome secondary to an accessory muscle: A case report

The flexor digitorum accessorius longus is a rare muscular anomaly that has been reported as one of the etiologies of tarsal tunnel syndrome. The authors provide a case report of a patient with tarsal tunnel syndrome that resolved with resection of the flexor digitorum accessorius longus. The patient remains asymptomatic 40 months following surgery.     

Medial tarsal tunnel syndrome: a review

The medial tarsal tunnel syndrome is a compression neuropathy involving the tibial nerve or its branches as they pass through the tarsal tunnel under the flexor retinaculum. Medial tarsal tunnel syndrome is not recognized as readily as its counterpart in the wrist. This syndrome can lead to a painful burning sensation in the medial border of the foot and into the great toe. In its fullest extent medial tarsal tunnel syndrome can involve sensory changes in the heel and the lateral part of the sole of the foot as well as the remaining toes. In addition, it may lead to weakness of the intrinsic muscles of the foot. This syndrome often goes unrecognized or misdiagnosed particularly in the athlete. While medial tarsal tunnel syndrome may respond initially to nonoperative techniques of ultrasound and modification of footwear, as it progresses surgical release of the nerve in the tunnel will be required for optimal results. This paper reviews the anatomy, etiology, pathology, clinical presentation, and treatment of the medial tarsal tunnel syndrome. In order to bring more attention to this condition, our clinical experience is presented.J Orthop Sports Phys Ther 1984;6(1):39-45.     

An outcomes analysis of surgical treatment of tarsal tunnel syndrome

Sixty patients (68 feet) underwent tarsal tunnel release for the tarsal tunnel syndrome and were re-examined objectively and clinically after they had reached maximum medical benefits and returned to their usual and customary lifestyle and employment. All of the patients demonstrated both a positive tinel sign and an abnormal motor nerve conduction velocity measurement. As determined objectively, there was 85% complete symptom relief. As determined subjectively, there was 51% symptom relief. Additionally, there was significant improvement in the quality of work, job productivity, and interpersonal relationships. There was a clinical dichotomy, however, between the objective pain relief measurement in contrast to the subjective patient's assessment.     

Acute carpal tunnel syndrome: a case report

We describe the development of acute carpal tunnel syndrome in a 53-year-old female following intensive repetitive use of the left wrist for two consecutive days.     

Unusual cause of carpal tunnel syndrome: a case report.

An unusual case of compression of median nerve at the wrist is described due to a foreign body. In unusual presentation of carpal tunnel syndrome, ultrasonography of the wrist is recommended to rule out a foreign body in the region.     

Trapeziometacarpal joint osteoarthritis and carpal tunnel syndrome: a new surgical approach for concomitant treatment

A new approach for the concomitant surgical treatment of trapeziometacarpal joint osteoarthritis and carpal tunnel syndrome through the same incision is described. The technique was used in 25 patients (20 women, five men; mean age, 56 years). At a mean follow-up of 27 months, there was complete disappearance of the symptoms of carpal tunnel syndrome in 20 of the 25 patients, incomplete but substantial relief in four patients, and no improvement in one patient. One patient had scar tenderness and another had a superficial wound infection. The surgical technique is simple, safe and cost-effective as it avoids separate operations for both pathologies. The procedure is not suitable for severe carpal tunnel syndrome or when direct visualization of the median nerve and the carpal tunnel is necessary.     

Iatrogenic posterior tibial neurothlipsis: a tarsal tunnel syndrome

Posterior tibial neurothlipsis in the retromalleolar space, secondary to internal fixation of a prior ankle fracture, is presented in the following report. The possibility of a tarsal tunnel syndrome cannot be ruled out. No apparent similar reference is made in the medical literature concerning the above etiology of posterior tibial compression/neurothlipsis/tarsal tunnel syndrome. Electrodiagnosis with sensory nerve conduction velocities is reviewed for more accurate diagnosis of tarsal tunnel syndrome.