BACKGROUND: Tarsal tunnel syndrome (TTS) is an entrapment neuropathy of the posterior tibial nerve or its branches within its fibro-osseous tunnel beneath the flexor retinaculum on the medial side of the ankle. It is a rare but important condition which is regularly under diagnosed leading to a range of symptoms affecting the plantar aspect of the foot. Management of this entrapment neuropathy remains a challenge and we have therefore reviewed the published literature in an attempt to clarify aspects of initial presentation, investigation and definitive treatment including surgical decompression. We also assessed the continuing controversial role of electrodiagnostic techniques in its diagnosis. CONCLUSION: Recommendations from literature: Excellent results with decompression in selected patients. To prevent nerve fibrosis, decompression should be performed early. Remain aware of false negative NCS (under-diagnosing of those with symptoms but ‘normal’ NCS. Role of NCS remains controversial with inability to predict which cases respond to decompression. Poor outcome may be due to nerve fibrosis.
BACKGROUND:Tarsal tunnel syndrome (TTS) is an entrapment neuropathy of the posterior tibial nerve or its branches within its fibro-osseous tunnel beneath the flexor retinaculum on the medial side of the ankle. It is a rare but important condition which is regularly under diagnosed leading to a range of symptoms affecting the plantar aspect of the foot. Management of this entrapment neuropathy remains a challenge and we have therefore reviewed the published literature in an attempt to clarify aspects of initial presentation, investigation and definitive treatment including surgical decompression. We also assessed the continuing controversial role of electrodiagnostic techniques in its diagnosis. CONCLUSION: Recommendations from literature: Excellent results with decompression in selected patients. To prevent nerve fibrosis, decompression should be performed early. Remain aware of false negative NCS (under-diagnosing of those with symptoms but ‘normal’ NCS. Role of NCS remains controversial with inability to predict which cases respond to decompression. Poor outcome may be due to nerve fibrosis.