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. 2008 Nov;105(45):776-81.
doi: 10.3238/arztebl.2008.0776. Epub 2008 Nov 7.

Posterior tarsal tunnel syndrome: diagnosis and treatment

Gregor Antoniadis, Konrad Scheglmann

Posterior tarsal tunnel syndrome: diagnosis and treatment

Gregor Antoniadis et al. Dtsch Arztebl Int. 2008 Nov.

Abstract

Background: Posterior tarsal tunnel syndrome is an uncommon clinical entity which is sometimes misdiagnosed in patients with pain of the retromalleolar region and the plantar aspect of the foot. Surgical intervention is recommended for correctly diagnosed posterior tarsal tunnel syndrome.

Methods: Selective literature review.

Results: Surgical treatment is indicated in the presence of dysesthesias refractory to conservative treatment or of neurological deficits. If a neural tumor or tarsal tunnel ganglion is suspected, diagnostic imaging (MRI, neurosonography) should precede surgery. Division of the flexor retinaculum (ligamentum laciniatum) in the tarsal tunnel must always include distal decompression of the end branches of the tibial nerve posterior to the fascia of the abductor hallucis muscle. Only extensive exposure of the nerve guarantees adequate release.

Conclusion: Accurate diagnosis requires the evaluation of relevant clinical, neurological, and neurophysiological findings along with the careful consideration of other possible diagnoses. High success rates of 44% to 91% are reported after operative treatment. The results are better in idiopathic than in posttraumatic cases. If surgery fails, re-operation is indicated only in patients with inadequate release.

Keywords: compression syndrome; diagnosis; nerve lesion; tibial nerve; treatment concept.

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Figures

Figure 1
Figure 1
(a) A woman with type 2 neurofibromatosis and a plexiform neurofibroma of the tibial nerve in the posterior tarsal tunnel. Partial division of the flexor ligament (arrow) (b) Tibial nerve release by complete splitting of the flexor retinaculum (arrow) prior to tumor resection.
Figure 2
Figure 2
A 42-year-old woman with an electrographically confirmed diagnosis of left tarsal tunnel syndrome. Sensory neurography of the medial plantar nerve bilaterally reveals a decreased nerve conduction velocity on the left that renormalized after surgical treatment in parallel with clinical improvement
Figure 3
Figure 3
Long incision behind the lateral medial malleolus of the right foot
Figure 4
Figure 4
After splitting of the tunnel proximally and distally, the tibial nerve and its plantar branches are decompressed
See this image and copyright information in PMC

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