The Triple Compression Stress Test for Diagnosis of Tarsal Tunnel Syndrome

The Triple Compression Stress Test for Diagnosis of Tarsal Tunnel Syndrome

Authors: Amr A.K.H. Abouelela^a, Abeer K. Zohiery^b

Affiliations:

• ^aDepartment of Orthopedic Surgery and Traumatology, Ain Shams University Hospitals, Cairo, Egypt
• ^bDepartment of Physical Medicine, Rheumatology and Rehabilitation, Ain Shams University Hospitals, Cairo, Egypt

Publication: The Foot 22 (2012) 146–149

Introduction

Tarsal Tunnel Syndrome (TTS) is a compressive neuropathy affecting the posterior tibial nerve or its branches as it passes through the tarsal tunnel. First described in 1962 by Keck and Lam, the syndrome can cause symptoms such as numbness, burning, or tingling in the toes or sole of the foot. These symptoms often worsen as the day progresses and may include nocturnal pain and cramping in the foot's longitudinal arch. The diagnosis is primarily based on clinical examination, though electrodiagnostic tests are also used despite their high rate of false negatives.

Methodology

This study introduces a new test, the Triple Compression Stress Test (TCST), designed to elicit stress on the posterior tibial nerve to provoke signs of entrapment. The test involves positioning the ankle in full plantar flexion, inverting the foot, and applying constant digital pressure over the nerve. This was tested on 50 patients with suspected TTS and 40 healthy volunteers. Both groups underwent basic clinical examinations and electrodiagnostic tests, with the TCST applied bilaterally.

Results

The clinical TCST was positive in 93.8% of symptomatic feet, successfully provoking symptoms in 6 new asymptomatic feet. The electrodiagnostic TCST revealed additional cases of TTS not detected by basic NCS, proving it to be a more sensitive diagnostic tool. Overall, the clinical TCST had a sensitivity of 85.9% and a specificity of 100%.

Conclusion

The Triple Compression Stress Test (TCST) is a simple, fast, and reliable method for diagnosing Tarsal Tunnel Syndrome, significantly enhancing the sensitivity of both clinical and electrophysiological assessments.

References

1. Keck C. The tarsal tunnel syndrome. J Bone Joint Surg 1962;44A:180–2.
2. Lam SJ. A tarsal tunnel syndrome. Lancet 1962;2:1354–5.
3. Turan I, Rivero-Melián C, Guntner P, Rolf C. Tarsal tunnel syndrome. Outcome of surgery in longstanding cases. Clin Orthop Relat Res 1997;343:151–6.

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