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. 2015:15:103-6.
doi: 10.1016/j.ijscr.2015.08.033. Epub 2015 Aug 28.

Tarsal tunnel syndrome masked by painful diabetic polyneuropathy

Tugrul Ormeci  1 , Mahir Mahirogulları  2 , Fikret Aysal  3
Affiliations

Tarsal tunnel syndrome masked by painful diabetic polyneuropathy

Tugrul Ormeci et al. Int J Surg Case Rep. 2015.

Abstract

Introduction: Various causes influence the etiology of tarsal tunnel syndrome including systemic diseases with progressive neuropathy, such as diabetes.

Presentation of case: We describe a 52-year-old male patient with complaints of numbness, burning sensation and pain in both feet. The laboratory results showed that the patient had uncontrolled diabetes, and the EMG showed distal symmetrical sensory-motor neuropathy and nerve entrapment at the right. Ultrasonography and MRI showed the cyst in relation to medial plantar nerve, and edema- moderate atrophy were observed at the distal muscles of the foot.

Discussion: Foot neuropathy in diabetic patients is a complex process. So, in planning the initial treatment, medical or surgical therapy is selected based on the location and type of the pathology. Foot deformities can be corrected with resting, anti-inflammatory treatment, appropriate shoes, orthesis and socks, and if required, ankle stabilization can be attempted. If the patient is still unresponsive, surgical treatment may be applied.

Conclusion: It is essential to investigate more localized reasons like tarsal tunnel syndrome that may mimic diabetic neuropathy, should be treated primarily.

Keywords: Diabetic polyneuropathy; Magnetic resonance; Pain; Superficial ultrasound; Tarsal tunnel syndrome.

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Figures

Fig. 1
Fig. 1
Nerve conduction studies of bilateral posterior tibial nerves. Med. Malleo: medial malleol, Pop. Fossa: popliteal fossa, ADQ: abductor digiti quinti, AH: abductor hallucis.
Fig. 2
Fig. 2
Well circumscribed, anechoic cystic lesion (asterisk) adjacent to the posterior tibial artery and vein (arrows) in the medial foot.
Fig. 3
Fig. 3
(a) Axial T1 turbo spin echo (TSE), (b) axial short tau inversion recovery (STIR) TSE, (c) axial post contrast T1 spectral presaturation with inversion recovery (SPIR) demonstrate T1 hypointense, T2 hyperintense and peripherally contrasted cystic lesion (ganglion cyst) (star) with closed relations in the flexor retinaculum (small arrow), medial plantar nerve (black arrow), flexor hallucis longus tendon (arrow head) and posterior tibial artery–vein (large arrow) positioned medially on the calcaneus (C) in the tarsal tunnel localization.
Fig. 4
Fig. 4
(a) coronal T1 TSE, (b) coronal short tau inversion recovery (STIR) TSE. Moderate volume loss in a and hyperintensity in b are seen in the abductor hallucis (small arrow) and flexor hallucis brevis (large arrows) muscles at the plantar side of the distal foot. The findings are compatible with muscle atrophy. (MT 1): first metatarsal.
See this image and copyright information in PMC

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