Authors: Luc M Fortier, Kenna N Leethy, Miranda Smith, Margaret M McCarron, Christopher Lee, William F Sherman, Giustino Varrassi, Alan D Kaye
Published: Orthopedic Reviews, Vol. 14, Issue 3, 2022
DOI: 10.52965/001c.35444
Introduction
Posterior Tarsal Tunnel Syndrome (PTTS) is an entrapment neuropathy due to compression of the tibial nerve or one of its terminal branches within the tarsal tunnel in the medial ankle. This condition, often compared to carpal tunnel syndrome, involves similar pathophysiological mechanisms but is rarer and poses diagnostic and treatment challenges.
Anatomy
PTTS involves the tibial nerve, which is significant for nerve signaling in the lower leg and foot. The tarsal tunnel, the main site for nerve compression, includes the flexor retinaculum and bones such as the distal tibia and talus, alongside other crucial structures like arteries, veins, and tendons.
Pathophysiology
The focal compressive neuropathy of PTTS can be triggered by various factors, including traumatic injuries, vascular disorders, inflammatory conditions, and mechanical changes within the foot.
Clinical Presentation
Patients typically present symptoms such as numbness, burning, and paresthesia in the heel and along the medial side of the ankle and foot, which are exacerbated by prolonged standing or walking.
Diagnosis
Diagnosis of PTTS is based on physical exam findings, particularly a positive Tinel sign, and can be supplemented with imaging studies like MRI or ultrasonography for detailed views of the anatomical structures and potential lesions.
Treatment
Conservative Treatment
Initial treatment often includes activity modification, pharmacologic management, and physical therapy. If these measures fail, more intensive options like orthotics or even surgical interventions may be considered.
Surgical Treatment
If conservative treatments are ineffective, surgical decompression of the tarsal tunnel may be necessary to relieve the pressure on the tibial nerve and alleviate symptoms.
Conclusion
PTTS, while rare, is a significant neuropathic condition that can severely impact mobility and quality of life if untreated. Proper diagnosis and timely treatment are crucial for effective management.
